HomeMy WebLinkAboutBuilding Permit Application (2) RECEI1 ._ FEB 2016
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:, NotApplicable
Name: Name:
Address: Address:
City: C,d.
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.ttiat 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;l do hereby agree tl;at I;will, in all respects,perform the w-ork•1
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 pogls,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
comm "cg work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder s
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFC)i�it^ �l �fT COUNTY OF ���
The forgoing instrument was acknowledged before me The forgoing instrutrpent was,acknowle.dged before me
this day of T 20 1 Toby. this day of I Cbz G�C� r LL_: ;20by
V,,
(Name of pe on acknowledgi ) (Name of person ack wledging)
1 R C
Signature of Notary Pube-State of Florida) (Sign ture of Notary blic-State of Florida)
Personally Known OR Produced.Identification Personally Known OR Pi'oduced`identifcation
Type of Identification`Produced I T e of Identification Produced .
GWENDOLYN F.DEISS / Q ;}.!"•,,
199 ati �( pa� WENDOLYNF.DEISS
Commission No. +: lea YCOMMISSIONAFF21995 C mission No. ;•S`IGIYOMMISSIONpFF219959
, mss EXPIRES:August 13,201 � , = EXPIRES:August 13,2019
Bonded Thiu Wft Pobrk Unde rs s'�; Y\°�' Bonded Th
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE -
COMPLETED
Rev.7/2014