HomeMy WebLinkAboutBuilding Permit Application �
Building- - Permit-'-~ ' �rp-c---'-'' �
'DESIGNER/ENGINEER:Not Applicable MORTGAGE COMPANY: Not Applicable
Nar'rle• Name:
Address: Address:
City: State: city: State-
T1 p:
tate-Zip: Phone:
IMPLE TITL,IE HOLDER: _Not Applicable ROI11Dirws 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.
5t.Lucie County makes no repre.enc tion that Is granti_ng 2 permit will authorize the permit holder to build file subject stru4ture
which is in conflict with any apphcab�e 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 respect:,,perform the work
in accordance with the approved plans,the Florida Buildigg Codes and 5t.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 faildre to Record a Notice of Commenimment may result in your paying twice for
}m rovements 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 our Notice of Commencement.
Signature of owner/Agent/Lessee Signature ofContra�nse holder
STATE OF FLORIDA L,V C t e STATE OF COUNTY Q FLORIDA
COUNTY OF S 5T.
T LV , P .
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .20_ by this , day of .20 by
�ur f iC S4rnrnanS S-Ammdn C_
(Name of person acknowledging) (Name of person acknowledging)
U664-Z411--rw Z 411-0147x ' -
(Signature of Notary Public-Stateof Florida) (Signature of Notary Public-State of rida)
Personally Known OR Produced identification Personally Known '� OR Produced identification
Type of Identification Produced Type of identification Produced
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Commission No. �$sh y * 1) EXpIRES:Apr14.4017 Commission No. 4Zrjf /4/ * #�
�rp eeaeedlMo9udax ! EXPIiIES:Apr�14,?01
4+�s 8e�d�d
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DAVE
COMPLETED
ev.