HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4
Date: 9i4 fir Permit Number:
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&ANg A A��AA V
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City%:
City:
State:
State:
Zip:
Phone
Zip:
Phone:
FEE SIMPLE TITLE HOLDER: —
Not Applicable
BONDING COMPANY:
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
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 empt from undergoing a full concurrency review: room ad ' ons,
accesslory structures, swimming pools, fence ,walls, signs, screen rooms and accessory uses to another n-residential use
WARNING TO OWNER: Your failur o Record a Notice of Commencement may result i your paying twice for
improvements to yo �operty Notice of Commencement must be recorded d posted on the jobsite
before the first in ectiq►n. If u intend to obtain financing, consul I lende or an attorney before
commencing w or r cord' a vour Notice of Commencement.
i
Signature of Owne Lessee tractor as Agent for Owner
Signature o ntractor/ rise Holder
STATE OF FL RID
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STATE 0 COUNTY FLO A ��+►1�
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COUNTY OF •
The f r ing instr en a ack o ledg efore me
ti day of 20'rby
The r oing instr ent was accnow .dg efore me
thi day of QQ(( 20X by
Lam N as"t
Name o person statement
Personally Known OR Produced Identification
Name offpepron making statement
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
Produced
Produced
1 t!W�
'OW VlJ�7v'
(Signatur Notary Public- State of Florida )
(Signatur Notary Public -State of Florida)
commission No i 1 a
mi ion No Goof ($ �PublicStateofPiori
Notary Public State of
Amy N Wood
1 r N Amy N Mod
MtY Commanion GG 2
1645 Ex Commission 22 241
Expires 07M512022
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REVIEWS
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REVIEW
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DATE
RECEIVED
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DATE
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COMPLETED
Rev. 8/2/17