HomeMy WebLinkAboutBuilding Permit Application (2)SU PLEMENTAL 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.
1 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 Horne 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.
01
Si tune of owner/ Lessee/Contractor as Agent for Owner Si., ature of Contractor/License Holder
STATE OF FLORIDAc �I. STATE OF FLORIDA r
COUNTY OF , - - 4i COUNTY OF -
The forgoing instrument was acknowledged before me
this day of 20 1 V by
Na of person making statement
Personally Known 7/ OR Produced Identification
Typeof Identification
Produced
(5ignOture of Notary Pu is ,tardapf Florida 1 MIKE MARTIN
Commission No. o'+� += No ry Public - State of Florid
•; mssion #E FF 216951
'sY;Fors�'- My Comm, Expires Apr 5, 201
Bonded through National Notary As;
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
RECEIVED
DATE'
COMPLET
Rev. 8/2/17
The forgoing instrument w s acknowledged before me
this jC- day of +�. r ' 20 I "Y by
Nime of person making statement
Personally Known �"' OR Produced Identification
Type of Identification
Produced
iature of Notary Pubic 51;6► .qf Florida
ed�a,a MIKE MARTIN
» c,'s_ Notary Public - State of Florid
mission No. ; = dI�sion # FF 216951
��� My Comm ExplresApr 5.201
Bondedthroug,±'.t. cgalNotary A&
PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW