Loading...
HomeMy WebLinkAboutsneed 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Nat Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: State: Address: City: State: City: Zip. Phone Zip: - Phone: BONDING COMPANY: Not Applicable FEE SIMPLE TITLE HOLDER: 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 is in which 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 our Notice of Commencement. Sigh re of Owner/ Lessee/Contractor as Agent for Owner Si nature of Contractor/License Holder STATE OF FLORIDA COUNTY OF STATE OF FLORIDA may` . COUNTY ©F 6� `� L- " The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 15— day of /- e— 20 it by this 5 day of Jae� 14— 20 1$ by c, I:, r"1 cli rl !l 11,/C!5 C. Y► CIII—) —lame of person,Ing statement Name of person Making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public- State of Florida } (signature of Notary Public- State of Florida } Commission No. �.++++p�,,R (Seal) MIKE MARTIN C mission No. ay11Q1j•4 (Seal)MIKE MARTIN p,`� =: Notary Public -State o1 Flor a Notary Public - State o1 Flan :: • Commission # FF 2116951 _ ; •- Commission #� FF 216981 ovity WWI loll.. REVIEWS FRONCIP", T I PAP Illy as Apr 5. 20 OF n ANS VEGETATION '"'++"++ edt ru ja o y COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 -