HomeMy WebLinkAboutScan_0003SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
Not Applicable
State:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY; Not Applicable
Name:
Address:
Address:
City:
The fo ing instru ent was acknowledge before me
this day of 20J by
City:
Zip: Phone:
Name of pers making statement
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.
U('LA�. L (i,>'v/
Ual� L (e_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF .46c�"L,.
The fqfjoing instru ent was acknowledge before me
this day of , 20 by
The fo ing instru ent was acknowledge before me
this day of 20J by
Name of pers making statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commis
Commission No. (Seal)
Notary Pilplir Stats of Florida
Suzette Ritchie
State at Fiorld#
GO 35735
Notary pub4ic
Expire+ 1211
REVIE
2t521
UPERVISOR
i4
PLA
Suze miss}i n�rO 1357315
€�E�UNw 2IPA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
°t
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17