HomeMy WebLinkAboutklepper 2SYPPLEMENTAL; CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: , Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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_
Sig re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA., STATE OF FLORIDA
COUNTY OF J� f . . _( ICOLINTYOF
The for oing instrument was acknowledged before me
this day of ✓A .' 20 icy by
�.� �j ► .ems r-�
Name-4 person making statement
Personally Known i� OR Produced identification
Type of Identification
Produced
(Signature of Notary Publ'-rFbhla]y Pii6lic -State of F
•= Commission # FF 21ti!
Commission No. t�Iinm. Expires Apr 5,
''' ° �+ �`'��, Bonded throitch National Notar
REVIEWS I FRONT ZONING
COUNTER I REVIEW
RECEI
COMPLET
Rev. 8/2/17
The for oing instrument was acknowledged before me
this i day of y Zp 15 by
Name of person making statement
Personally Known i-- OR Produced Identification
Type of Identification
Produced
MIKE MARTIN
f Notary Public- Yatary Public - state of
' Commission # FF 21
z'
No. `��, SVgRomm. Expires Apr;
.,a;,,�„� Bonded through National Not
SUPERVISOR PLANS I VEGET)
REVIEW REVIEW REVIE
kTION
W
SEA TURTLE
REVIEW
MANGROVE
REVIEW