HomeMy WebLinkAbout621 Ash Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: L
VNot Applicable
Name:
Address:
Sig urer f Con icense Holder
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
,� Not Applica ale
BONDING COMPANY: XNot Applicable
Name:
Address:
The forgoing instrument was acknowledged before me
Address:
City:
this *=qday of ���, 20� by
City:
Zip: Phone:
Name of person making statement
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is h 2reby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prio - 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, do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Buildir g Codes and St. Lucie County Amendments.
The following building permit applications are exempt fro n 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-workor r ording your Notice of Commencement -'-)
Rev. 8/2/17
Signature o caner/ a see/Co
ctor as Agent for Owier
Sig urer f Con icense Holder
STATE OF FLORIDA
S F I A
COUNTY OF
COUNTY OF S� . Uujc' e
The forgoing instrument was acknowledged
before me
The forgoing instrument was acknowledged before me
this tt�'day of
20A by
this *=qday of ���, 20� by
?)Cr-., )arra J ;mer cZ
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known Y— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
17
( ignatu of otary Public- Stat f.F r'd
tdre of Notary Public- State o
Commission No, �
public Stats of F //+� II�� �I[[�� 11�� J� � Notary PubNc state of
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My Commisswn GG 024 < My Commisslon GG
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i Expires 00!25"2020
gxpires 08125J2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17