HomeMy WebLinkAboutBuilding Permit Application (2)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
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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
commencing work or recordoiVg your Notice of Commencement.
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Signature of Owner/ Agent/ lessee
STATE OF FLORIDA )
COUNTY OF Jf oeee k
The forgoing instrument was acknowledged before me
this day of M 4LCY6L 20_ by
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Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF ��
The forgoing instrument was acknowledged before me
this .�_'- day of M A 2C rt- 1201 6 by
Lie, 7-1s � .n In"p-5
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- Stat f Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. C �� �% * WY�I
J EXPIRES: April 4
f4r� cs Fl •� B�1 Thri gadget
(Signature of Notary Public- State of 71, da )
Personally Known OR Produced Identification
Type of Identification Produced ,
4� ......."� SH
Y COMMISSION a EE 859
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✓54E�'#mission No.�rCO S / ` EXPIRES: April 4, 2017
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Serves ,F F, c� Bonded Th u Budget Notary Service
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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