HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
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DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address: 4252 Bandy Blvd.
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: _ N,ot Applicable
N a me: Micheal Flaxman
Address:
City: Fort Pierce State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 sul�jgct structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with 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 your paying twice for
improvements to your property. A Notice of Commencement must be recordedand 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. '1010,
Signature
as Agen`t•for Owner
,__ . . _ _
STATE OF FLORID-
COUNTY OF
thisiykftrum t �S i nowle20gbfore me
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Name of a on making statement
Personally Known OR Produced Identification
Type c Ide_ ntifjcatirVAQ
Produce
ignature �f Contr*tpr/License Holder
STATE OF FLORI@AA I I , n . \
COUNTY OFy� J_._,1.(.l'-/y
The r?ng instru ent w do cnowledge fore me
this. a) of 20 y
Name of pe5kon making statement
Personally Known I "- OR Produced Identification
Type of Produced ent' icW6D aCcl L C_Yl a ( .-)
( inn ture of Notary Public- State of Florida)
(SighAure of Notary Pbblic- Sta,�jlp#Ifrjpfjga %
Commission No.
(Seal)
Commission No.
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REVIEWS
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SUPERVISOR
PLANS
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REVIEW
REVIEW
REVIEW
f�„��E}A�.•
REVIEW
DATE
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//ODATE
RECEIVED
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COMPLETED
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Rev. 8/2/17