HomeMy WebLinkAboutBuilding Permit Application 11/08/2016 l0:05 9549773591 PERMITS PAGE 02/05
11/08/2016 10:06 9549773591 PERMITS PAGE 03/05
MO "y }
tfi
11
?�
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 dead 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$t,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 nonresidential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resuranpa-5ttarney
paying twice for
improvements to your property,A Notice of Commencement must be recorded ed on the jobsite
before the first inspection. if y ntend to obtain financing,consult with lender before
commencin ork or recordlOg V.6ur Notice of Commencement.
s
Signature6F her/LepAe/Con1lactor as gent for owner Signature o Contr t r/License Hoider
STATE OFrFLCORID STATE F FLORf A
COUNTY oF__ - COUN OF
The f oing instrume #vyas acknowled d before me The f rgoing instrument wa ac owledged before me
this day of _ U' 29 by this f day of /t V .ZO / by
(Name of person acknowledge g) (Name of person acknowled )
not of Notary Public-S to of Florida) Signa ure f Notary Public-Statid
Florida)
Person`I Known Personal! nown, _oR Prcedidentification
Type of Identification Pr ' 'gipp"�S x ar t�1 #7F0M Type of identification Produced
XP4RE5:UGtognC�tlnde 'sn
Commission No. ennaae �lCommission No. 9HERIF
'eiJfiy MYCOMM►SSI t165a3t
FF
1S9t 21 20i7
lb
Revised 07/15/2014
',A Hondad f1+nt NoU+ry puu n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS