HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
'BONDING COMPANY: XNot 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
-ommencing worK or recorcling Vour Notice of Lomrnencement.
Sig tore of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Halder
STATE OF FLORIDA
COUNTY OF
The fev� oing instru ns acknowled a efore me
this LL day of 20 by
1
Name
am-
Name of pe making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Com ISS1Qr1NO. - - Fforitla
Suzette Ritchie
u I My cammiasltn GG 135736
STATE OF FLORIDA
COUNTY OF i�
The for oing ins nt was acknowledgW efore me
this I day o� 20by
Name of pers aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
�Z, J gat -J•d"- -------
(Signature of Notary Public- State of Florida }
- -
Iseal)
,ya.Y htotary Public State o lorida
Suzette Ritchie
MV Commission GG 135738
REVIEWS FRONT ZONING SUPERVISOR P -SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17