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'AL CONSTRUCTION UE N LAIN INFOR MATIC3hi;
DESIGNE
Name:
Address:
Ivity:
Zip;
GINEER:
Phorle
Not Applicable
State;
MORTGAGE COMPANY:
Name;
Address:
City;
Zip: —... Phone:.
Not Applicable
State:
FEE SIMPLE TITLE FOLDER: Not Applicable BONDING COMPANY: --Not Applicable
Name; Name,
Address: Address:
City; City:
Zip: Phone: Zip: Phone -
OWN E R/ CO h TRACTOR AFFIDVIT: Application is hereby made to abtain a permit to do the work and installation as indicated,
I certify that no i vork or Installation has commenced prior to the issuance of a perm it -
St, Lucie Counttyy akes rte representation that is granting a permit will authorize the permit holder to build the subject structure
which is in Cortfli t with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or pfchi bit such
structure. PI ea-w consult with your Home Owners Association and rf�vir*w your deed for any restrictions which may apply-
ln consideration the granting of this requested Permit, I do herebyr agree that I will, in all respects, perform the work
in accordance wi h the approved plans, the Florida wilding Codes and St Lucie County Amendments.
The following bit (ding permit applications are exempt from undergoing a full con currency review; room additions,
accessory strutt resr swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residentlal use
WAR NING TO OWNER: Your failure to Record a Notice of Commencement may resuk In paying twice for
improvements to your property. A Notice of Cornrnencernent 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 lend e r or an atto rn ey before corn mencing work or recording your Notice of Commencement.
of 0+ner/ Lessee/Contractor as Agent for Owner
STATE OF F
COUNTY 01
M
4hys
or a irmed) and subscribed before me of
icai rese ce o Online Notarization
this day of 2020 by
r-w 1 ti �
' \�
of per-506 making statement.
Personally Known OR Produced Identiticatian
Type of IdeMilfi ation
Produced
(signature of Notary Public- State of Florida j
Corn misslon N
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Contractor/License Holder
STATE OF FI.0R
COLINTYOF
SwarR461or affirmed) and subscribed before me of
P ysical Prose r�ee or Online Notarization
tt+is . dayaf 2020 by
t �'(PPL
Name of person making statement.
Personalty Known OR Produced Identification Z
Type of Ide fication
Prod�+ced s t
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(5i ctary Public- State of FloridaPIP
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