HomeMy WebLinkAboutBuilding Permit Application 7728710883 p.2 K8imndmP|umb�g&AC
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SUPPgL-EiVIENTALRUCTION:
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DESIGNER/ENGINEER- Not Applicable MORTGAGE COMPANY:+ Not Applicable
Name: I Name:
Address: ( Address:
City; ) I State: City: State:
Zip: Pho e: I Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BLINDING COMPANY: _Not Applicable
Name: 1 Name:
Address: I I Address:
City: ! I city:
Zip: Phone: I Zip: Phone:
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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 in�epresentation
allation has commenced prior to the issuance of a permit.
St.Lucie County makes no that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Home Owners Associatlon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w th your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the gra ting 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 5t. Lucie County Amendments.
The following building per1 it applications!are exempt from undergoing a full concurrency review:room additions,
accessory structures,swim nling pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure lto 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
beforqAbe first inspection. Ifyou ir>(tend to obtain financing,consult with lender or an attorney before
conimeribing work or Ifecording your Notice of Commencemen
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Signatu a of Owner/Agen�/Lessee sign athreS ontractor/License Holder
STATE OF F1.0f�Ip � STATE OF FLORI*, (
COUNTY OF
t cli t_, COUNTY OF t L.' .` c
The oin Inst t s acknowledged Wore me
g ,1>4 Na , The E�pomg inst me t w acknowledged before me
this day of '` 20by ,?`" r�A.� this ay of ,1 20�by
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{Name o person acknowlddSing) m o (Name f person ack wledging) c`a
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Signature of Notary Public-State or Florida) p Signature of Notary Public-State of Florida) 21
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Personally Known OR Produced Identification Personally Known L!_
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OR Produced identification
Type of Identification Pro aced Type of Identification Produced
Produced
Commission No. C=L� +i �j j {Seal) Commission No.L:-t 1�a 035' (Seal)
Revised 07/1512014 ' {
REVIEWS FRON1 ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNT R REVIEW REVIEW REVIEW, REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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