HomeMy WebLinkAboutBuilding Permit Application SUPPLEMMNTALCONSTRUCTION LIEN LAW fNFbRMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Ad d ress:
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 thepermit 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 IMPROYEMENIS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SJYE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER opeArkATToRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of wner/Lessee/Contractor as Agent for Owner Signature of Contras or License Hol ?---
STATE OF COUNTY OF FLORIDA STATE OF a I COUNTY OF ORIDA�\_
The forgoing instrument was acknowled before me The fo oing instrne t was acknowledggd efore me
this�dayof- InnA�,v+-�,20)E by this�� day of �Y-LJ_ �.r'-(20L�by
N \ - ,k n' i L)
i ILL P,-' W t 'M' i i L&I
Name of person making stat ent. Name of person making statement.
Personally Known OR Produced Identification Personally Known mvgsOR Produced Identification
Type of Identification Type of Identification
Produced Produc
to 4,kyl—L :5', AAjOl
(Signature of Notary Public-Sta of Fin Weill Lyne WiIkIn (Signature of Notary Pub -Stat 1F idfr�li�Lyne Atkin
AR y � NOTARY PUBLIC
Commission No. o° T Y PUBLIC Commission No. f--�Tf OF FLORIDA
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l Comm#GG103860
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Expire 9/4/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.