HomeMy WebLinkAboutmobil 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address;
State: City: State
City:
Zip: Phone Zip: Phone:
FEE ;I PLE TITLE HOLDER: 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.
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, consu't with lender or an attorney before
commencing work or recordigg your Notice of Commencement.
Sin re o Owner/ Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder
STATE
COUN ®OF FLORIDA 5_ ti Jr, , e COUSTATNTOY OF FLORIDA
The forgoing instrumentf was acknowledged before me
this4�dayof �? i[�Lrt 201 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced `
(Signature of Notary Public- State of Florida )
Commission No. ; � (SeakiIIKE MARTIN
�•�Notary Public - State of Florida
i� './•= Commission 0 FF 216951
REVIEWS COO -+ ,REVIEW REVIEW
mom.
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this �_ day of C + �°t::�y—Y , 20IL'by
iq'ame of person making statement
Personally Known ___1e:: bR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu li - S t f to 'd
�� MIKE MARTIN
ommisslon No. �•Notgq%Ric - State of Florida
• . • Commission # FF 216951
My Comm. Expi as Apr 5, 2019
' PLANS REVIEW I VEGETATION— REVIEWREVEWL� I REVA ffIEW