HomeMy WebLinkAboutBuilding Permit Application `
772-336-9032 P2
Jun O118O1�3p Jack Frost A/C nfGoFla
Jun 0116 01:33p Jack Frost A/C of So Fla 772-336-9032 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: —State:
Zip: Phone: Zip: Phone-,
FEE SIMPLE`TITLE HOLDER: x Not Applicable BONDING COMPANY- x 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 instariation 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 thework
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 t first inspection. if you intend to obtain financing,consult with tender or an attorney before
commefting work or recordinFyour Notice of Commencement. A
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Signat 0 ne Agen essee Signature ' tractor/License Holder
FLORIDATA OF STATE Signature
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COUNTY OF SL Lucie COUNTY OF St Lucie CL M _ N
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Thef Wng mstru=t was acknowledged berbrRrL%c> Q The forgoing instrurient was acknowledged
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this 7 —day of 20M e >. 0 12- this I 5X day of 1JJ&hA== 20W by Id r3 It
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Jacques C.Stlegeirpan wJacques Q. Stiecielmap,
(Name person ackn gi fName
of pe on acknowledg!
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nature of Notary Public-State of Florida (Siggna-A)ure of Notary Public-State of Florida
Personally Known XX OR Produced Identification NfA Personally Known XX OR Produced Identification NIA
Type of Identification Produced Type of identification Produced
Commission No. FF007935 (Seal) Commission No. FF007935 (Seal)
Revised 0711512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED f