HomeMy WebLinkAboutpermit application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
(Seal)
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
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Address:
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City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Address:
Not Applicable
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 dome 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
-ommencing work or recorcling your Notice of commencement.
Signature of Ownerl Lessee/Contractor as Agent for Owner Signature of Contract r icense Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instr en s acknowledged before me
this day of 20_0 by
6'�� 11L (--A" llk_=�
Name of pe son making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
STATE OF FLORIDA
COUNTYOF
The fo mg ins me t as acknowledged before me
this day of ° 20LI by
41% 1
Name of paPn making statement
Personally Known t✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
Commiss•y
(Seal)
SUZETTE Fti7CHIE,''
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M 7 SUPERVISOR
FgB y1(1=GET 'r RTLE MANGROVE
COIADITkftfaro s REVIEW
RE
IEW REVIEW REVIEW
DATE
DATE
COMPLETED
Rev. 8/2/17