HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 thepermit 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
commencine work or rec42wdin-a vour Notice of Commencement.
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Signature of Owner/ Les ee/Contractor as Agent for Owner Signature of Contra cto icense H Ider f
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �IaeCOUNTY OF
The fo oin instru nt as acknowled efore me The f r oing instrumentlwas cknowledge fore me
this day, f i. 20�by this�d f I 20Y
4 ^
Name of person making statement Name of person ma -Ung statement
Personally Known F/ ,R Produced Identification Personally Known_OR Produced Identification
Type of Identif" ion Type of Identific n
Produced Produced
"k Nemogs
Signature of Notary Publ' A 'da) O9 ( gn ture of Nota a ori�I MMMICR GG141442
iomhalon # GG141442 �+� ar
Z ?►_ - - May 4, 2421
Commission No. I (StPl $: May 4, 2421 Commission No.
Bonded Ifni Aaron Notary ��ilAffllil4\ n thru Aaron Notary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED v —_
DATE
COMPLETED
Rev. 8/2/7.7