HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONTION:
DESIGNER/ENGINEER: .
Not Applicable
MORTGAGE COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
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State:
City:.
State:
Zip: Phone
Zip: Phone:
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FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
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Name:
Name:
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Address:
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Address:
city:
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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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit -
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 Commence ent must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain fina cing, consult with lender or an attorney before
commencingwork or recordingour Notice of Com ncement.
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Rev. MPLEMEN7'A!. GQN� ION L N LA IN J-R=�AA_
DATE
MY CONI December
Sig e o Owner/ Lessee/ ontractor as gent for w er
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S�Irs 1..�ci�t
COUNTY OF �
The forgoing instr ment was acknowledge before me
� �
The forgoing instrument was acknowledged before me
this � day of Ny , 20 �� by
this day of , 20_ by
Name of person making statement.
Name of person making statement.
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification '
Produced L-
Produced
(Signature of Notary P blic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. w4s� C('S`�`�SSIOK#GG072020
. Commission No. (Seal)
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