HomeMy WebLinkAboutBuilding Permit Application -NU
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:—
Address: Address: State:
City: State: City:
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 confi ict 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
commencft work or recording your Notice of CommencemeRO A
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Lit A I&I-
Slgnatur6 of 0%4ner/.Agent`/Lessee Signature of 1pntractor/License Holder
- 1 1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF &evad'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this U day of Ma�j 20 1 S- by this I I day of 20 15' by
I
Geof-�e s 6,co (;P.0fqe Shau) -
(Name of p rson acknowledging) (Name erson ac nowledging)
(Signature li6-9tate of Florida
(Signa6re&'�ofary, Public----ate of Florida P
Ul Ipt
Personally Known OR Produced Identification Personally Known v/ OR Produced Identification
Type of Identification Produl Type of Identification Produggo
SHAWINA LOTES
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Commission No. C mission No.
EXPIRES:Nommber 14,2015
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REVIEWS TRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW RF:X11C1A1 REVIEW REVIEW.
DATE
RECEIVED
DATE
COMPLETED
v.7/2014