HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAIN 1N��ORMA IQ
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:----;.- Address:
City: Stater 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 M'ay'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 o recordingApfr Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner . Signature of Contractor/License Holder-
STATE
olderSTATE OF FLORIDA, 6STATE OF FLORIDA
COUNTY OF LlI(,I COUNTY OF
The for oing instruirqerlt was acknowledge efore me The forgoing instru ent was acknowledge before me
this day of 20-M by this_Wday of �6,0 ;20�by
(Name of person acknow edging) (Name of person acknowledging)
(Signat a of Notary Public-State of Florida) / (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification vl Personally Known OR Produced Identification v
Type of Identifi Type of Identificati
Produced Produced
, KAREN S, NIELSEN 'OIPFYPUel4 S. NIELSEN
;,o,�+` �e,., � os State of Flon�a- )tar
,_ ;State of ii o-Notery Public y Public
Commission.No. _ Commission No. =* *= ommissi� G 207484
Comms # GG 207484
My•Cprnmiglan Expires l;o°�� My commission Expires
June 12 2022 June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 7/2014