HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINE• • Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: tate: City: / State:
Zip: Phone Z'e. Phone:
FEE SIMPLE TITLE HOLDER: _Not Ap• ' BONDING COMPANY: _Not Applicable
Name: Name:
Address: A:. ,ss:
City: City:
Zip: one: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to .0 the work and installation as indicated.
I certify that no work or installation hascommenced 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
commencin: work or r- •rdin: o otice of Commencement. e
d " 4OPPIP -z
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-I &AA.-- COUNTY OF S
The forgoing instrume t was acknowledgedbefore me The forgoing instrum t was acknowled before me
this l U day of 20 jS by this U day of ,201.61_ by
aam
aLLperson acknowledging �
V�
Name of personacknowledging) V
(Signature of Notary blic-State of Florida) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification'
Type of Identification Type of Identification3
Produced S' 1L s t Produced 'L-1 L � =—"' ARFEG1Vni�S
L GYvFN� c-nNSFA GG
i�°.�``•t=.` 0"r."� � �F a.,, SIGN� -
�� NN _ G � tvM1Y G��FJIFS batF"'
�� ?+•' � 071. r� � xe
Commission No.L fa f, �F,t•(Se�A' q AF;`�°`�. Commission No. t'£ 4 �XFFF<es�(�p�`,)ba,.
j I C O _ Haas t dso 1, ;" d lleN /cii. '
EXPIn �v vubl\oUu 0� r ?off; 6onde
REVIEWS . FR tNT ONZ ING SUPERVISOR PLANS . VEGETATION - SEA TURTLE MANGROVE
COU TER. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
RECEIVED
DATE
COMPLETED
Iev. 7/2014