HomeMy WebLinkAbout2416 Atlantic Beach Blvd0002 SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Na 1.,.,fm e:Iris Reick N a me:Joe ouan
Address:2416 mantic Beach Blvd Fort Pierce,FL 34949 Address:
City: State: City: Port St Lucie State.
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:1687 SW South Macedo Blvd 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature o t actor/License H der
STATE OF FLORIDA STATE OF IDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by thisJE"j2 day of Vhc-_,r �_V\ ,20A by
Name of person making statement Name of pe n making statement
Personally Known OR Produced Identification Personally Known ¢R Produced Identification
Type of Identification Type of Identification
Produced Produc d
A AA A A -4-1 IL't Q A-1 AA__)
(Signature of Notary Public-State of Florida ) ( ignature of Notary Public-State df Florida)
Arians U i o
Commission No. (Seal) Commission No. S OTARY �C
WSTATE OF FLORIDA
.�_ Comm#GG185914
c�t Expires 2/141 022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17