HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
e:
_ Not Applicable
Address:
City:
Zip: Phone
Stat
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMP
Name: /
_Not Applicable
Address:
Address:
City: Z
City.
Zip: P ne:
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 sticture
which is in conflict with any applicable Home Owners Association rules, bylaws or ano covenants that may restrict or prohibit such
structure. Please consult wRh 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
STATE OF FLORIJDq �,�� � CSTATE OF OUNTY F O� O y.
COUNTY OFA
The fo Ding inst ment was acknowledged before me The forgoing instru ent was acknowledgpd b.fore me
thi a of 20�Jby this2svay of 20LO by
Name of person eking statement Name of perwrymaking statement
Personally Known=OR Produced Identification _ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Commission No. �IS`eal)
M1/3313
REVIEWS
Rev.
FRONT
COUNTER
*1
Commission
PLANS I VEGETATION
REVIEW REVIEW