HomeMy WebLinkAboutSIGNATURE PAGE17SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name,
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITTLE HOLDER. Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
certify that no work or installation has commenced prior to the issuance of a permit.
5t. 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 l 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
commencing work or recording your Notice of Commencement.
Sigrfature of Owner/ Agent/ Lessee
STATE OF FLORIf(A
COUNTY OF tf C4`G'/
The forgoing instrument was acknowledged before me
this _py'i' day of "5�, 1, 2013 by
(Name of person acknowledging)
(Signature of Notary
Personally Known
Type of Identificatiorlc
..Q
Commission No.
Revised
Revised 0i/i 5/2014
M
of Contractor/License Holder
STATE OF FLORI!�14
//
COUNTY OF Ityl C oo-c'
The forgoing instrument was acknowledged before me
thisAl"day of 20EI by
(Name of person acknowledging)
WEdf FI'oiJ43_% (Signature of Nota-
l" u-'
P rcli tMob r-tfttw, cation Personally Known (
Type of Identification Prodw
n rvr t `
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PIANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED