HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENR: :-- t` pplicable MORTGAGE COMPANY' Not Applicable
Name: ./ Name:
Address: ''' Address:
City: /. State: City: / State:
Zip: .,-� Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: - Address:
City: City: r
Zip: / Phone: Zip: Phon
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.
Stl Lucie County makes no representation that is granting a permit will authorize thepermit 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
iniaccordance 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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ���
COUNTY OF S\ L_�C✓1% COUNTY OF -T•
The fo ng instrument was a no ledged before me The for ing instrume t was acknowledged before me
this R ay of N\b�6`M� O t�by this ot�day of IVO���F�-- 20_ by
Name of person making statement Name of person making statement
Personally Known ICOR Produced Identification Personally Known t-- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1
(Signature of No ry Public-Stat o FI rida) (Signature of Notary Public-,Sta e f F or:_ a -
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1 • 1)PAULETTE BLAIR-ALX sio o. 7 TJ k ,.2os *��e LETTE BLAIR-ALEX N ER
Commission No.
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;. ary Public-State of FI ida
Notary Public-State f Florida Commission; FF 99 6
%� Commission# FF 9 5699 'os9. My Comm.Expires Se 20
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REVIEWS FRONT ZONIN Sal rM S ' S VEGETATION ' SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17