HomeMy WebLinkAboutScan_20190711 (2)SUPPLEMENTAL CONSTRUCTION. LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY*• _Not Applicable
Name: Name:
Address: Address:
pity; 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.
certify that no work or installation has commenced prior to the issuance of a permit.
t; Lucie ou n makes r r e n tion that i granting a P it illauthorize thepermit bolder t build the subject structure
.. _ r an covenants that r restrict orprohibit such
which i in con ii with any applicable Hone Owners Association r�l� {bola
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 concurrencV review: room additions?
accessory structures swimming of , 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 PRflRERTY. A NOTICE OF COMMENC Off MUST BE RECORDED AND
P05Tm ON THE JOB SffE BEFQ THE FIRST INSPECTION. IF YOU lNTE111Q TO OBTAIN FINANCING, CONSUL'
WITH YOUR LENDER.OR AN AT'rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
F•�
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me for
this .-it- day f 20 by
'Name of persbn raking statement.
Personally Known Produced Identification
Type of Identification
Produced
r -
( i n atu r I to ry Pu bi ic- Sta to of F I o ri d a
Commission No. (Seal)
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
f
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
N ci3 i y p utatic State of F Toil
Iz Donna Mahan
f 18:2022
k
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY of
The for owing instrument wps a n d edged fore me
this day of 20 b
Name of person maing stake meat.
Personally Known - E VProduced Identification
Tire of Identification
Produced
r
(Signature of Notarv,FPubli - State of Florida
Commission No.eel
L
PLANS
REVIEW
VEGETATION
REVIEW
i
(seal)
SEA TURTLE
REVIEW
MANGROVE
REVIEW
' f p u t)l k Slate of Florida
Catherine Donna Mahan
0