HomeMy WebLinkAboutapplication page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Nancy Hayes
MORTGAGE COMPANY: Not Applicable
Name: Kenneth H. Geary
Address: 7961 HORNED LARK CIRCLE, PORT ST,LUCIE, FL 64952
Address: 7961 Homed Lark Circle
City: PortSt.Lucie State:_^
Zip: Phone
City: Stuart State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Add resS: 3669 SE Salerno Road
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
commencing work or recording your Notice of Commencement.
Rev. 8/2/17
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Signature of Owner/ Lessee/Contractor as Agentr Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF /11✓e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this f day of _0c, -f- h e /L 20 t 7 by
this 11 day ofQC-r&6e–.A', , 20 1-2 by
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Personally Known OR Produced Identification
Type of Identification
Type of identification
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(Signature of Notary Public- State of Floric �ptp SheW
(Signature of Notary Public- State of FloricbMpheD Shea1r
Commission Na. �(�� t19olFlorida
COmmisslon Expires 06/06/202
(ja ��L St tall Florida
Commission No. __ My �rOfT)si Expires 06106/2021
OF Commission No. GG 112238
Commission No. GG 112236
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17