HomeMy WebLinkAboutalex 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ^ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
State:
Address:
City: State
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Add Tess:
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 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 acccrdance 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmpricing wnrk nr rer_ording your Notice of Commencement.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA //
��
STATE OF FLORIDA
COUNTY OF G� �-c a
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of i 6^-cc_cy// y�� 20 0 by
this day of J c tom! �c rr , zQ by
i
Nara of person rn ing statement
Personally Known � OR Produced identification
Name rson making statement
Personally Known t.�OR Produced Identification
Type of Identification
Type of Identification
Produced #AiITiN
Produced
Notary Public - State of Flori0�
Commission rt
J n 18, 2
y Comm, Expires Jun 1il. 2423
(Signature of N
(Signature of Notary P gtoslij - State of Flonda
Commission No. (Seal)
Commission # GG 3463!
Commission No. My COMM, gg1r,�� Sun 18, 2423
Bonded through,4�t 1. Notary Assn.
Jill
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17