HomeMy WebLinkAboutPage 2 Permit Application SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: x Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State:_ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: 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 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 o urjgaice of Commencement.
Si atur f Owner/Lessee/CQDIWctor as Agent for Owner Si tur Contractor/Lice older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF&L-- COUNTY OF s,—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2+ day of oeramo� 20 1-1 bythis Z2Ifcday of D e-CG - .20A by
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification_ Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of No (Signature of NotaPubli -State of Florida
SHIELLY
&IRES:Ad1g3E'20
Commission No. S; � BARRM
MYCdipFpW05g Commissio ygypgga
EXPIRES:Apd 2a,~ p f EXPIRES:Apnl 23,20ta
eomea ilwY welt UnhnnAm x2Bf„h• 9oiwa tNu rkwr PoUIc v.aen�w.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17