HomeMy WebLinkAbout2nd page permitSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Add ress: Address:
State
City: State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE 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.
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 thepermit 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 reccoordinA our Notice of Commencement.
Sigrfature of Owner/ Lessee/Contractor as Agent for Owner
Signatufe of Contractor/License Halder
STATE OF FLORIDA -
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this--dayof ,20'by
this dayof 'fir rf—Ir, 201 'j�'by
r
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Natar' Pge Flan
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Cam i FF 218951
No. :; y p �� r
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« + •Cammissian # FF 216551Commission
Commission No. '."t `Q`,= b y Offs .}Expires Apr 5, 2 1
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17