HomeMy WebLinkAboutBuilding Permit Application (2)I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
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 Count 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, l 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,
accessary 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, consu't with lender or an attorney before
commencing work or recording your Notice of Commencement_
.r
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF J4 , �+ a t
STATE OF FLORIDA
5
COUNTY OF C
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _Lip day of 20 by
this l dayjof _ ,) i.,k V 20 ] °J by
1,
f` 0i ' toolLn
Name'of person! m ing statement
OR
Name person making statement
Personally Known ^� Produced Identification
Personally Known I,,*- OR Produced Identification
Type'of Identification
Type of Identification
Produced
Produced
(Signature of Nota d!i!�!lF�knM4d(
(Signature of Notary Pub f F�g�ri;Ift MA
sir "�" :. MIKr RAY MARTIN
,y1 -, �ratary f'utill�e a of Florida
Commission No. {omm;ssi � 346354
i7lic •State of Florida
�js`- Commission GG 346354
Commission No. w o� � . My Coff$Mores Jun 18. 2023
My Comm. .xpires Jun 18. 2023
Bonded through rational Notary Assn.
Bonded through yahonal Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATIT
RECEIVED
DATE
COMPLETED
tev. 8/2/17