HomeMy WebLinkAboutBuilding Permit Application (2) SUPRLEMENTAt CONSTEC7'tON LIEN LAW INFQRMATiQN: ° w
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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
corrimpi;pIng work or recording-your Notice of Commenceme
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Signa re of Own r/Lessee/Contractor a Agent for Owner Signa ure of Con ractor/License Holder
10STATE OF FLORIDA ST TE OF FLORIDA 1
COUNTY OF COUNTY OF
The fprgoing instrum nt was AcknowleclgpA.before meThe r oing instru nt was cknowledge efore me
this day of 20 by this day of 20 b
L---x 'a 17 � 11
Name of persoh making statement. / Name of person Making statement. x/
Personally Known OR Produced Identificationy Personally Known OR Produced-Identification
Type of Identific tion Type of Iden ' ' ion-
Produced Produced
(Signature of Notary Pu lic tate of Florida) (Signature of Notary Public-Sttateeof FI ri a
KAREN S. SEN °w"'� _KAREIJr� EL'SEN
Commission No ta`Y'�a'.. I Commission No. �"�P e:::
_ rtESef Floriaa�r ut ry Public to of F;agiiy� �tary Public
Commission # GG 207484 =+ Commission #GG 207484
M til Comrnission Expires
%nnn�� June 12, 202 ° %rine`` une
REVIEWS ISOR PLANS VEGETNT MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.9/26/18