HomeMy WebLinkAboutBuilding permit application 2.pdfSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
Address.
City: State:
dip: Phone
FEE SIMPLE TITLE HOLDER:
N a iii e:
Address:
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_Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name}
Address:
Citym. State:
Zip: Phone -
I BONDING COMPANY:
Name:
Address-
Zi P: i Phone: zip: Phone,
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby niade to obtain a permit to do the work and installation as indicated.
t certify that no work or installition has commenced prior to the issuance of a Permit.
Not Applicable
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 appticable 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 �nd St. Lucie County Amendment.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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 i n paying twice for
improvements to your property. A Notice of Commencement must be recorded in the pLiblic records of St.
Lurie 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 your Notice of Commencement,
Signatup6,6; Contractor - or - Own'�r Builder as applicable
11/
STATE OF FL7A400"Zj-4
IDA COUNTY OF
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Sworn o (or affirmed) and subscribed before me of
this day of Ar, tl , 20a-Rby
Name of person making statement.
Personaiiy Known DR Produced Identification--,Yo
Type of identification Produced
JaysJayson Bono
NOTARY P E3LI
M STATE OF RID
m# GG293561
E 1� Expires 112212023
Physical Presence or Online Notarizition
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(Signature of Notary Public- state of FlaridalW,4 ay$°n
bono
NOTARY PlJ13LlC
Commission No. (Seal) 0SSTATE OF FLORIDA
r Ctxnm# GG293561
.s-'�CE 14Expires 1/2212023
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev 1011-2/21
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW