HomeMy WebLinkAboutBuilding Permit Application S PPI 9N1'AE` -0 TT.
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DESiGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: 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 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
commencingwork or recordingour Notice of Commencement.
Signa a of Owner/Agent/Lessee Signatucw6f Contractor/License Mder
STATE OF FLORI STATE OF FLOR DA
COUNTY OF Ct COUNTY OF
The for oing instru e t was acknowledged before me The f r oing instr nt was acknowledged before me
this�ay of 0 —,20 t�by this qday of�_ .20[Mby
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Pu ([� p�6orida)• >;, nature of Notary PAW.
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Personally Known iuc2d{ elft , 'n Personally Known aduon
Type of Identification Pro4a 1J ¢ Type of Identification Pr"•uc
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Commission No. i�Z, *..�j X., Commission No.
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED