HomeMy WebLinkAboutPage 2 Permit appSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Not Appl able
Name:
_
MORTGAGE COMPANY: of Applicable
Address:
Name:
City:
Address:
Zlp: Phone
State: City' State:
Zip: P ne:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable BONDING PANY:
— _Not Applicable
LZCity: I Add
s:
-
iP: i hone: y'
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated
I certify that nyo work or installation has commenced prior to the issuance of a permit,
St Lucie
wh ch s nocoMlict with any applicable repret is sentation
Asssonting ciationir lesaby aws or and covenaholder to build the nts that may restrict of 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 N YOUR PAYING
TPOSTED ON THE JOB WICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMEIYCEMENi MUST BE RECORDED AND
WITH YOUR LENDER OR µE BEFORE THE FIRSTFORE NSPECiN)N, F YOU INTEND TO OBTAIN FINANCING, CONSULT
�\ EY BEFORE RECORDING YOUR NOTI[F nF
Signa of Owner/ Lessee/ ctor� Agent re caner
Sigriafuo(Contractor/License Holder
STATE OF FLOR _ vv
COUNTY OF�, LLB e STATE OF FLORUM1 �� ����
COUNTY OF
The rg ing instru ent was acknowledi; efore me
this,nday of (C.,l, The for o g instru t knowled
20 --/ by this g efore me
[�ay of _. 20� by
Name of person making statement Name of person making statement.
Personally Known _� OR Produced Identification J
YPe of Identification Personally Known OR Produced Identification
Produced Type of Identification
` \„N111g11p/��f �� Produced J /
�j jLf %�A 'Wa=�/i//
( gnature of Not Public- Sta[�bf FT • id )d ' • l� ��
* : (Signature of Not P blic- Stat ci Qbrid�
Commission No. •'•
Commission No, r eat
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REVIEWS FRONT I ZOff
ISOR /i it�as •. \��
COUNTER REVIEW �N 1► PLANS VEGETATION SEATUR�(�� .
SATE VIEW REVIEW REVIEW REVIEW 'ry uirNl`7