HomeMy WebLinkAboutBuilding Permit Application Page 2Name:
Address:
City:
Zip: Phone: _
FEE SIMPLE TITLE HOLDER--
Name:
OLDER:Name:
Address:
City:
Zip:.
Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone_
I certify that no work or installation has commenced prior to the issuance of a permit.
✓Not App{icable
State:
Applicable
St. Lucie County.makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conict 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, 1 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 recording your Notice of Commencement. _
essee/Agent
STATE OF FL(?!rl _ � i 1�
COUNTY OF 1� �"
The fo oing in t)uas atknowledg before me
this day of ill 2aby
4-iZt� - bw Vi (y) VVI � 1
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known v OR Produced Identification
Type of Identifies
Commission
Revised 07/15/2014
.� L — s
or/License Holder
STATE OF FLORIDAI p �
COUNTY OF
The ing inmerit wa acknowledg d before me
this day of rl I 20 by
71.r,o,n acknowledging/)
A�J --
(Signature of Notary Publl¢- State of Florida )
Personally Known �// OR Produced Identification
Type of identification Produce,� �i M
MY COMMISS FF904048 { Commission No.
EXPIRES July I. 2019 I
MMISSION # FF904
EXPIRES July 31, 2019
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INMALS