HomeMy WebLinkAboutPermit application (2) 01
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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: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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,l 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
commencin work o—pfkci"Ming your Notice of Commencement.
S'ignatur wner/Agent/L, see' Signature of ontractor cense Halder
STATE OF FLORID ' ` '. STATE OF FLOR ,Q
COUNTY OF COUNTY OF C U-2&41 t
The forgoing instrument was ac nowledgetl before me .The forgoing instrument was acknowledged before me
this day of ' , 2016 by this day of ,26 U by
40
(Name of person acknowledging.) (Name of person acknowledging)
of N ary Public-State of F rids)
'c- tate of orida (signature
YAN
(Signature of N ary Publi S )
Personally Known OR Proe€�`ideni� NPAGE 0567 Personally Known v OR Proc� ldentification
Type of identification Produced * M9 Type of identification Produced �°="''•G° MARYANN PAGE
* * 227561
'l„�TFOF�Ce. Bonded thn�9adgel Notary Servic �, + '*MIRES:May 5,.2019
Commission No. (Seal) Commission No. ''�cx����O ruBudget NotirySerrkes
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
COMPLETE
INITIALS
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