HomeMy WebLinkAboutBuilding Permit Application �
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Jun 2O1811;�7e Jack Frost AJCofGoFka �
Jun 201811:47a Jack Frost A/C of8oFla 772-338-9032 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER., x NotApplicable 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 orinstall2tion has commenced prior to the Issuance of a permit.
St.Lucie CountV 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 @no covenants that m estrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any re t on . ch 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:roarn additions,
accessory structures,swimming pools,fences,wells,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 fcir
Improvements to your property.A Notice of Commencement must* recorded and posted on the jobsite
before ft first inspection. If you intend to obtain financing,consulVWith lender or an attorney before
comme/nding workAr recording your Notice of Commencement.
=FLORIDA CO STATE OF FLORIDA
COUNTY OF St Lucie z St. Lucie C*
COUNTY OF
Z IL
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Jacques C.Stieg2lman Jacques C.Stiegelman
(Name of person acknowledgin (Name of person acknowledging)
�Sidi�ture of Notary Public-State of Florida) (Sign, re of Notary'Public-State of Florida
Person'allv Known-_ XX OR Produced identification NIA Personally Known , XX OR ProdUcedJdentffication N/A
Type of Identification Produced Type of Identification Produced
Commission No. FF007935 (Sea]) Commission No. FF007935 (Seal)
Revised 0711512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIV
DATE
COMPLETED