HomeMy WebLinkAboutEM 2SUPPLEMENTAL 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.
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 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
commencing work or recording our Notice of Commencement.
ture of Owne?7 Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STA�TNE OFFLORIDA
5� � / i STATE OF FLORIDA //
.0 t e -e_COUNTY OF /fi t r
The forgoing instrument was acknowledged before me
this 142— day of 20by
4 1 a�
Name of person king statement
Personally Known OR Produced Identification
Type of Identification
Produced
The forgoing instrument was Icknowledged before me
this JXday of /i& ve e.'- 20 ny
d& Cq—, c i M., ,n
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publ Soap,%% Florida ) MIKE MARTIN ( gnature of Notary Public- t�. +P" jda j MIKE MARTEN
:•* *`� ; Notary Public - State of Florl a �+ Notary Public - Stats o}
Commission No. = ., iSSlan # FF 216951 x.
( C mission No. SeAmmission # FF 21
o�• My Comm. Expires Apr 5, 20 9 s r My Comm. Expires Apr i
ii,�*`�, Bonded through NatlOnal Notary s ,�� Bonded through National Not
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA. TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW I REVIEW
RECEIVED
Rev. 8/2/17