HomeMy WebLinkAbout7203 (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: T Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
EEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 thepermitholder 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, wails, 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
commencine work or recordine vour Notice of Commencement_
Signa a of ner/ Lessee/Contractor as Agent for Owner
.- LIL49
Sign f Can or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF--
COUNTY OFs--
The foy.going instru ent was acknowledged before me
1 `f 12
The forgoing instrument w s acknowledged before me
jH M c� r4 r) 1S
this day of Gt r6 20 by
this day of 20 by
Gary w_ ZaneBo
Gary W. Zando
Name of person making statement
Name of person making statement
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Qaliie
le Biglin
-����( COMMISSt
NFF904099
{Signature of Notary Pub i - State of Fltsr ,c` wVYN� AAO
'
N �i7�lre of Notary Publics arida
6MISSION IFF901099
'a,,IfUFR���
Commission No. FF9014099 {Sear
= EXPIRES: Aw t 25, 2019
Commission NO. FF901099 ~�......`Q'`
�; :-` (YtW&RONNOTARY.CaM
'If? Utt���y
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/27