HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: JIL Not Applicable 1
Name:
Address:
MORTGAGE COMPANY:
Name:
Address:
jC Not Applicable
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
l..+F`1-�;o-i-r�.Y
City:
Zip: Phone:
Zip: Phone:
Type of Identification
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. I
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 attorney before
commencine work or recording our Notice of Commencement.
Rev. 8/2/17
Si ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA-
STATE OF FLORIDA `(
COUNTY OF
COUNTY OF t�
The forgoing instr.m t w s acknowledged before me
this day ofd 20 by
The forgoing instr m nt w s acknowledged before me
this day of lug 20 �� by
�
� ' �
l! Gb'y�•- F� ``_ i �
l..+F`1-�;o-i-r�.Y
_ _l
Name of pers making statement
Personally Known i OR Produced Identification
Name of person making statement
Personally Knowni` OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
5-,( OLAklbl::�__Z
PZ_Z�_
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- Stat
Commission No.
Cam i SCZETT Iit1Cs 1� al}
ZET-i E RITCHIE
®`<
_+; MY CCPR i7
5 De b®r 12, 20
G®rCl
`
=op
�4SS1rJh� #�FFO61$6$���
gip+1CP1Fli~
Cprtt
+ o41)358
RES O
_ember i2,
JUPERVISOR
fa15" pit
SEA TURTLE
MANGROVE
REVIE STrF<, .. FI UIV ian:
-ZPNJ1NG0M
PLA
EGETATION
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17