HomeMy WebLinkAboutBuilding Permit Application (2)SUP LEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Signature of Contractor/License Holder
STATE OF FLORIDA �
COUNTY OF • ��--. �
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _Not Applicable
COUNTY OF
The forgoing instrument as a�knawledged efare me
this day of ' ern. L*— 20 j �by
Name:
Name;
L'"z of 20� by
Address:
Address:
Na a of person ming statement
Na of personing statement
City: State:
City: State'
Personally Known � OR Produced Identification
Type
Zip: Phone
Zip: Phone:
Produced
FEE �IMP'Lf TITLE HOLDER: _Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Add ess:
C Ian # FF 2 ; •. C Ion # FF 246951
Address:
cFcd�A;.•`
B •{�." Banded through National Nf„ Bonded *DO National Notary Assn
City:
j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
City:
Zip: Phone:
Zip: Phony:
.
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
M hich 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 acco dance 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,
access ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor the first inspection. If you intend to obtain financing, consuK lender before
with or an attorney
com encin work or recordingour Notice of Commencement.
CD PLETED
Rev. 8) 2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �
COUNTY OF • ��--. �
STATE OF FLORIDA���
�� �
COUNTY OF
The forgoing instrument as a�knawledged efare me
this day of ' ern. L*— 20 j �by
The forgoing instr�ent ,as acknowledged before me
this day C
o
�
L'"z of 20� by
Na a of person ming statement
Na of personing statement
Personally
Known u' OR Produced Identification
Personally Known � OR Produced Identification
Type
of Identification
Type of Identification
Produced
Produced
Name:
{Signature of Notary P o aria MIKE MARTIN (Signature of Notary Pu ie-,4�a�be� ori a`j�"��KE MARTIN
Add ess:
C Ian # FF 2 ; •. C Ion # FF 246951
Address:
cFcd�A;.•`
B •{�." Banded through National Nf„ Bonded *DO National Notary Assn
City:
j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
City:
Zip: Phone:
Zip: Phony:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �
COUNTY OF • ��--. �
STATE OF FLORIDA���
�� �
COUNTY OF
The forgoing instrument as a�knawledged efare me
this day of ' ern. L*— 20 j �by
The forgoing instr�ent ,as acknowledged before me
this day C
o
�
L'"z of 20� by
Na a of person ming statement
Na of personing statement
Personally
Known u' OR Produced Identification
Personally Known � OR Produced Identification
Type
of Identification
Type of Identification
Produced
Produced
fi
{Signature of Notary P o aria MIKE MARTIN (Signature of Notary Pu ie-,4�a�be� ori a`j�"��KE MARTIN
Y Pie 'F
• : � Nota��llc - Stela of FIor1Aa
Commission Na. Commission No.
, NotaIIs -State ojAssn.
T.
C Ian # FF 2 ; •. C Ion # FF 246951
• My Comm. Expires ApS�±��4`�;' My Comm. Expires Apr 5, 2019
cFcd�A;.•`
B •{�." Banded through National Nf„ Bonded *DO National Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DA7
.
REC IVSD
DATE
CD PLETED