HomeMy WebLinkAboutScan_20190617 (2)SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Add ress: 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: W.
Zip: Phone: Zip: PhonePP
:
OWNER/ CONTRACTOR.
AFFIDVITO: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie County makes no red resentation that is grantingpermit will authorize the permit holder to build the subject structure
%.Wh ich i s In contlict with a ny a pplica Home Owners Association ruI * bylaws or a na covenants that may restrict or proMbit such
structure. Please consult with your Home wn r o latron and review your deed for any restrictions which may apply..
In consideration of the ra tir f 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. Lu se County Amendments. -
The following building permit applications are exempt from undergoing a full concurrency regrew: room additions,
access tru e r f i mi n pools* fences, walls, signs,, screen rooms and act or uses t another nor -r l nt luse
"WARNING TO OWNEW. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAGI RESULT IN YOUR PAYING
TWICE FOR 1141PRf]YEMrM'S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED Ail[0
PASTED ON THE JOB SITE BfFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER -OR AN ATTORNEY BEFdRE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner{ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this ZO- day of 4.-T2 ej 20A by
rLe r. I f{ _
(.era
Nameofpe n making statement.
Personally Known OR Produced I d ntl satin n
Type of Identification
Prod u cep
V .ell .1 Ir 1 9 V ff %- F x W -k
(Signature brNoLiary Public- State of Florida j
Commission Na. � (Seal)
Signature ofi Contractqt/ License Hower
f
STATE OF FLORIDA
COUNTYOF--
The far air�g instrument was acknowledged before me,
day of ��20,., by
A
Nam6 of person maingstatement.
l 42,S � hA (
Personally Known R Produced Identification
Type of Identification
Produced
[Signature of Notary. Public- State of Flanda
Commission Na. � ee
l (Seal)
r
REVIEWS FRONT ZONING SUPERVISOR � PLANS I VEGETATION SFATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev-27773�
I u bi fc. State of Florida
L Donna Mahan
1
MANGROVE
REVIEW
I P'Ju Notary Public- State of Florida
Catherine Donna an
� MyComrnlss,on GG 1768$1
i
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