HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
X Not Applicable
BONDING COMPANY: XNot Applicable
Name:
Address:
The forgoing instr a as acknowledged before me
this day of 20 by
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.
terrify 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 Horne 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 recordine vour Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
4Z_
STATE OF FLORIDA
COUNTY OF_ � � rr
COUNTY OF� _
The for sing instrumen was acknowledged before me
The forgoing instr a as acknowledged before me
this day of 20 by
this day of 20 by
Name of person king statement
Mame of persg�•making statement
✓✓
Personally known =OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
eye •
� 4
_-_—
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Co al}
i'''AY pllB . ,[.[�y TTE RI-fCHIE
V L.E
',,�SPP'YPUA '- SUZETTE RITCHIE
`
`7
bra°` R `n`_ G 4FF061868
M4A} SlQN
'
`_ My cOiN1lElS5lO�I #FF081868
XF'lRES pec
REVV1�S^sF`° RQTa7Nuta
r
mbar 1?.
SUPERVISOR
PL
EXPIRES Doc mber 12, 2017
�13 ,Vgg;ETAFTcilG�J4 to SE&T RTLE
MANGROVE
c407
EVIEW REVIEW
REV
VIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17