HomeMy WebLinkAboutBuilding Permit Application Page 2- rSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
rDESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
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Narne. Ndme. _ _
Address: Address
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
' "Jame: ":arnc:
Address: Address:
City: City:
Zip: Phone: I Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated
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S: Lucie County makes no representation that is granting a pet ma will authon2e 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, perfurm the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
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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 {ender or an attorney before
commencinx work or recording our Notice of Commencement-
Slgnafurg f Owner/Lessee/Co factor as Agent for Owner Slgnat re of Contractor/License Holder_
STATE OF FLORIDA STATE OF FLORIDA�7
COUNTY OF -� P_ COUNTY OF
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The f rgoing instru nt as adenowled{ before me The f { ing instrument was acknowledge efore me
this Aladay of 20 by thisday of 20y
Name of pers ti making statement Name of perso aking statement i
Pe.cnnally known OR Pmdored IAentihr0inn Personally Known OR Produced Identification
1 l ype of Identification type or Identification {
Produced Produced_
(SignaturCof blk-State of Florida I (Signature of Notry P blic-State of Florida (
Commission No. Commission N _
SHELLY A BARREfT rjp+^"%y SHELLy A BARRER
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REVIEWS F R I PLANS V TA GROVE
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DATE
RECEIVED
DATE
CDMPLETfD
Rev. 8/2/17 --- —--_
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