HomeMy WebLinkAboutBuilding Permit Application (2) SU.PPL'EMENTAL`CONSTRU,CTI.O:N LIEN LAW INFQ'RMATION
DESIGNER/ENGINEER: _Not Applicable_ MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:. •
FEESIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby madetoobtain a permit to do the work and installation as indicated.
1 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'a.pply.
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. .
Thefollowing.building permit-applications are exemptfrom undergoing'a full-concurrency review:,room additions;
accesso y structures,swimming pools,.fences,walls,signs,screemrooms'and'accessory uses.to another n"on-residential use
WARNING TO'OWNER:Your failure.to:Record a.Notice of Commencement may result in your paying twice for
improvements to your prope'rfy. A Notice of'.Commencement must be recorded and posted on the jobsite
before,the first inspection. If you intend to obtain fnancing,,consult with lerider.or an.attorney before
commencing work or recordin our Notice of Commencement.
Signa t re of Owner/Lessee/Contractor as Agent for Owner StgnalUre of Contractor/License Holder
STATE OF FLORIDASTATE.OF FLORI
COUNTY OF—2:T LtAeo c COUNTY OF� a-
The forgoing mtr ent was acknowledged.before.me Theforgoing instr m rrt was acknowledged before.me
this, day of rtc 20il by this day of 20LQ by
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Name of person making.statement ame of per"son making statement
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Type o ation ��.;�., USAMANN Type of I entificati :�g`• 'r uSA
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I. :March 9,2019 Banded Thru rdotary Fabric Underwriters
Banded3hmNotaryNbficUrd6rwRers �" •'•-
(Signa are of.•Notary-Public-State of Florida) (Signature of Notary, Public-State of Florida).
Commission No. (Seal) Corimission.Nd.. (Seal)•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17