HomeMy WebLinkAboutBuilding Permit Application (2)SU PLFMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Na'e:
Name:
Add�ess:
Address:
City State:
Zip: Phone
City: State:
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.
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 s 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
WAR14ING 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 pasted on the jobsite
before the first inspection. If you intend to obtain financing, consu It with lender or an attorney before
commencing work or recording your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STA �E OF FLORIDA c STATE OF FLORIDA
COUNTY OF - c �-f COUNTY OF r•
The forgoing instrument wt acknowledged before me
this day of
t _ e r 201_yby
Narfre of person ma�mg statement
Personally Known ✓OR Produced identification
Type of Identification
Produced
The forgoing instrument)yaj acknowledged before me
this day/ofc- t r 26 &-by
C. --RJ
Name a person raking statement
Personally Known l` OR Produced Identification
Type of Identification
Produced
(Signature of Notary ul16
� to of FloridmIXE MARTIN (Signature of Notary Public- S MIKE MARTIN
!Votary Public - State of Florida Oy
��Y°�e'Commission No. .=*`,n. No ry Public - State of
Comfitmdn # FF 216951 Commission No.
;� •� „•S a mmission # FF 21
My Comm. Expires Apr 5, 2019. My Comm. Expires Apr
Bonded through National Notary Assn, •;,�oF fL
►++„n�` Bonded through National Nol
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DAT
REC 'IVSD
DAT
COMPLETED
Rev. 8/2/17