HomeMy WebLinkAboutpermit1unit1pg2DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:_
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MORTGAGE COMPANY:
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BONDING COMPANY: Not Applicable
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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 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, 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: 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 attorn �efore
commencinfa work or recording vour Notice of Commencement. _ 'en
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID f
COUNTY OF
The forgoing instrum nt was acknowledged before me
this - &.— of J�Ue-f , 20_1 by
(Name of person acknowledging
(Signat of Notary Public- State of Flo da
Perso ly Known
Type of Identification
.�a� P
Produced L y ,'o,: °���, JUANITA GOMEZ
Notary Public - State of Florida
My Comm. Expires Feb 3, 2018
Commission No. , o °' &"ssion # FF 085970
of ConVa`�r/Lice`nle_'Holder
STATE OF FLORIDA t
COUNTY OF '54 - Lurk'e_
The forgoing instrument was acknowledged before me
this }day of �hVern bel , 20_�o by
(Name of person acknowledging )
a,- gr:�o
(Signature of otary Public- State of Flor a
Personally own OR Produced Identification _L–,-"
Type of Identificai n t�
Produced
mission No.
I1 JUANITA GOM
Kotary Public - State f I
My Comm. Expires Fe 3
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA 1011' '_XNG`R0V'P
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014