HomeMy WebLinkAboutScan_0002SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
ANot Applicable
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.
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 attorney before
_UII II I IrCi It -II IY, INU1 R U1 I UL.UI U1119 yUUI IVULIU= ill VUI I II I ICI IUZI IMI It.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF
COUNTY OF �_ �_oe COUNTY OF FLORIDA
The f9rZoing instrume t Was acknowledged before me
this day of ' 20 V1 by
Name of pers$n making statement
Personally Known 1�' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Com
SUZETTE RITCHIE
z+' My COMMiSStON #FF061B68
EXPIRES pe "ember 12. 2017
DATE
RECEIVED
DATE
COMPLETED
Rev. $/2/17
The foToing instrumen w s acknowledged before me
this c day of 2011 by
4
Name of peaking statement
rson
Personally Known �OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida
Commission No.
SUZETTE RITCHIE
JPERVISOR PLAIN5"'`i° , EGt�TATI'(71V j�SFA.YO'i�"fLE I MANGROVE
REVIEW REVilu 7i� °11-11 � 41o€ I Iidat�ot�rys ��r�grr�, REVIEW