HomeMy WebLinkAboutst lucie county appl 5.18.18.1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
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 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 O�®RI
/Lessee/Contractor as Agent for Owner Signature of Contract /License Holder
STATE OF - DA STATE OF FLO ]DA__�( -e
COUNTY OF COUNTY OF �t
The for ing instrument was acknowledged before me The for. ng instrum cknowledged�fore me
this day of {�(l� 20 it by this�da of 20 by
Name of person paking statement Name of person m king statement
Personally Known "� OR Produced Identification Personally Known 6-"OR Produced Identification
Type of ldent `caion Type of Identificatj�-r
Produced Produced
T
gnature�of lVotary lic t id mmlaslon#GG1Q144 i ture of Notarypub • "Milt�ilssion#GGIO1442
c _ ?�= 2021
Commission No. �•, ' •..����wr {5 �rK ft4,2G21 Commission Na. %, Ift4,
'f,,,f,II% ' ed th Aaron No �,,,,,►•.' ru Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17