HomeMy WebLinkAboutBuilding Permit App Pg2SUPPL.ONSTRIGIONeCIEN 1 W RN
LEMENTA
ORIfATION. :
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name: Seaside Engineers/Edward Roske
Name:
Address: 4265 Both ct
Address:
City: State:
City: Vero Beach State: FL
Zip: 32967 Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
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
that may restrict or such
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants prohibit
structure. Please consultwith your Home Owners 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 to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing -work or recording our Notice of Commencement.
Signature of`Own r/ Les a/Contractor as Agent for Owner
Signature of Can actorf icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -tin
COUNTY OF Marti -
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Ph sical Presence or Online Notarization
x Ph sical Pre nce or Online Notarization
this day of 202py
Isday of 202� by
Jonathan Starrett
Jonathan Starrett
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
na ure of o ary Public- State of Joricla)
Sig tut of N a ublic- State of Flo d/a )
Commission No. GG235102 ��iS bblic state of Florida
mmission No. GG235102 r 1140.(SeWPublic of F,o
Rogers Staples
Commisslon GG 235102
` ti'Angela Staples
" w h1v Commission GG in
.Fires
1
REVIEWS
F
FRONTS �
a Expires
4;QI.wGt
PLANS
VEGETATION
SEA TU`RTLE,"-
COUNTED"
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.