HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
X Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY:
Name:
_&Not Applicable
Address:
City:
Zip: Phone:
City:
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
-ommencinz worK or recorainp- vour Notice of trommencement.
t 2J�_C_l L (��_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF t �0
The forgoing instrue t was acknowledge efore me
this t< day of ' 20 by
U"
ce.
Name of pe
rs making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
Notary Public State of Florida
The forgoing instr t was acknowledge before me
this � day of 201 by
—3 Nameof per n making statement
Personally KnoZOR Produced Identification
Type of Identification
Produced
•'�� ��Mom
(Signature of Notary Public- State of Florida )
Commission Go 135736
�MNtlsv202 ZONING S SUPERVISOR PLANS
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
r4 No ary Public State of Florida
s4� Suzette Ritchie s
461
044EV�1=41REVIEW`
ANGRQVE