HomeMy WebLinkAbout2028 Nettles-Rachwal-page-2.jpegSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
—Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto do the work and installation as indicated.
1 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 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 IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SrTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/license H er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ''i (Z of I,,'),.
COUNTY OF a
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of_ CI IA;)(X VIA 20( by
this _4 day of 16 iA 0.20 by
Cry l it C1gW1_
'M i CIJ AC( VJ
Name of person making statement.
Name of person making statement.
Personally Known —1—OR Produced Identifici
Jons
Personally Known _X__OR Produced Identificati
n 12
Type of Identification
N
Type of Identification
Produced
Produced
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(Signature of Notary Public- Statie of Florda)
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(Signature of Notary PubTic- State Flori )
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA'TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW,
REVIEW
DATE
RECEIVED
DATE
COMPLETED