HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONrimi�:IV�ib�r
RECEIVE®
O C T 12 2018
ST. Lucie County, permitting
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SUPPLEMENTAL CONSTRU'CTIO IEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name,:
Name:
AddreIss:
Address:
City: I
City:
Zip: Phone:
Zip: i Phone:
I
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 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 recorded 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.
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Signatu ie of Owner/ Lessee/C&1te%,tor as Agent for Owner
STATEJOF FLORIDA
COUNT OF
The forgoing instrument was acknowledged efore me
'O�/^ this l D day of OGt, 20by
J Name n making statement
Personally wn OR Produced Identification _X
Type of I ntifi n
Produc d
(Signatulre o r ublic- State of Florida )
Commi lion o. WPu i� J! ARESE
MY COMMISSION # GG260667
uP�oe EXPIRES: September 20, 2022
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF M Ax t-s A
The forgoing instrument was acknowledgecl before me
this 10 dayof OCA-ob-cr 20tir by
>.o i %{—
Name beperson making statement
Personally Known 0%. OR Produced Identification
Type of Identification
Produced
(Signatur tafy Public- State of Florida )
�om nj�is ' n No. J. SA�AOSE
MY COMMISSION # 00260667
�iFOPF��° EXPIRES: September 20, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/p
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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