HomeMy WebLinkAboutImage (8)UPPLEMENTAL CONSTRUCTION LIEN LAW INF ATION:
DE R/ENGINEER: _ Not Applicable
Name:
Address:
MO GAGE COMPANY: _ Not Applicable
Name.
Address:
City: State:
Zip: Tne
City: State:
Zip: Pone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:Zip:
City:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicted.
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 vour Notice of Commencement.
Rev. 8/2/17
Signature of C tracto icens older
Signature of ner/ tesse4Xontractor as Agent for Owner
STATE OF FLORID
STATE OF FLORInzefn
COUNTY OF
COUNTY OF In
The forgoing instr ment was acknowledge before me
The for oing inst ment wit; acknowledge before me
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this day of �� _ , 20J by
thisday of ` , 20 by
Name ofkeYs6w6.4ing statement
ame of pers makin statement
Personally Known i OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETAT
GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17