HomeMy WebLinkAboutHensley AC Permit App pg 2 001SUPPLEMENTAL CONSTRUCTION LIEN LAW INF€}RMATION.
DESIGNERANGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 -
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 Assoclatrots and review your deed for any restrict -sons 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 #obsite
before the first inspection. If you intend to obtain financing, consultwith lender or an attorney before
commencing work or recording vour Notice of Commencement_
Signature of Owner/ Lessee/Contractor Agent for caner
Signature of Contractor/license Holder
STATE OF FLORIDA.
STATE OF FLORIDA
COUNTY OE i I 1 i p ,
',�r'
COUNTYCIF (.cF a. ce,
The forgoing mr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of�% 20� by
this � day of 20a by
Mir,h4l F Fo41e�
ma U F Iv
Name of person aking stitement
Name of per7fitaking statalment
Personally Known OR Produced identification
Personally Known OR Produced Identification
Type of Identification
Tye ype of Identification
Produced
N'b a &tom
Produced
(Signature of Notary blic- State of Florida l
(Stgnatum of N Publi -Sta o F€ d
Comm rsss n k.. E J. C0 . Q
Public - SkW
Commission ?YN° ..'w, CHRISTINE J. CONWa83
Notary Public - State of Florida
-. •= Commission # GG 01
_ . • Commission # GG 01'?39
%?, et My Comm. Expires Aug 2REV€
1 r
..1. 1br
olary
s . ERVISOR
PLANS
V t
VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETEQ
Rev.8/2/27