HomeMy WebLinkAboutGdowik - Permit Application (3).pdf`9
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements t property. A Notice of Commencement must be recorded in the public records of St.
Lucie Count d p s ed on the jobsite before the first inspection. If you intend to obtain financing, consult
wi h I or an me before_commencing work or recordingour Notice of Commencement.
_�]/ :1��
Sig tt re Contr t - or -Owner Builder as applicable
;of
ATE ORIDA L U
OF
Swo o (or affirmed and subscribed before me of
Physical Presence or Online Notarization
this day of 1 20S7-by
C'T:)AA1e*6 I4:*MA1iiJ
Name of person making statement.
Personally Known OR Produced Identification
ed
Type o dentifica 'on r uciycL:
(Signature otary Public- Sfate of Florida)
Commission No. 1 ({ TZ (Seal)
ELIZABETH A. SCILER
Notary Public, State Of Florida
*
No. BB74732
Cammissmn
y Commission Expires: I22212034
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21