HomeMy WebLinkAboutScan_0002SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_KNat Applicable
MORTGAGE COMPANY:
Name:
—X Not Applicable
Add ress:
Add ress:
City:
Zip: Prone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
XNot Applicable
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 lobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
ommencin,R worK or recoratnR vour IVotice of uommencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrurQent was acknowledged efore me
this day of i k ° 20 by
Name of persont7 ing statement
Personally Known ` OR Produced Identification
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF R
The forgoing instrument was acknowledged me
this day of • ,I 20 by
Name of person making statement
Personally Known l-,-' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Commissi
'rw►- --
ayY ram Notary Public State 04 Ftori a
iF f Suzette Ritchie G {35736
,,F Expires `l2! E 212621
UNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/7.7
Commission No. (Seal)
t7o'yr+,� Notary Puhlic Mate t�f Flatida;JN suzette Ritchie _--
SUPERVISOR
REVIEW R
MANGROVE
REVIEW