HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_KNot Applicable
Address:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: �_ Not Applicable
Name:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
Not Applicable
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of`Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF &5v . UJQ, ,,C_ COUNTY OF &� . UAC !?
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this i day of _ `� 20 I1 by this�'1`�'Nday of "a __ 201t by
n XiI. k -N 1►'Y-cY_z
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced _
Bco jcxxy., n -�a ; nmre z
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Sigfia ur . o�N�t'ary Public Stat=.f_
'" '(�i atu'Fe d%N ary Public- a .e P o .i
Public-
Nc StateKFlo i" Notary Pubk State of Florida
Commission No. '� 2`� I Viana rarde ` p� Arg!!_T,�tiana Petdomo2612020 024 o i s s i o n N o. C OZi n�%f abtiirh6sslon GG 024960
kplmt 08!25/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE— ---- ---- —--------- -- -- ---- - - -- --- --- --
_ RECEIVED
DATE ------- -----
COMPLETED
Rev. 8/2/17