HomeMy WebLinkAboutBuilding Permit Applicaiton SUPPLEMENTAL CONSTRUCTION LIEN LAW]N FORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicabie
Name: Name:
Address: Address:
( City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:1816 SW BILTMORE STREET 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 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 jobsite
before the first inspection. if you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
t
Signature ner/Lesse Contract; as Agent for Owner Signature tractor/Lice Hoold/e�
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUIE COUNTY OF STLUCIE
The for oing instrument acknowledged before me The fing instrume t as acknowledged before me
this�day of � ,20,&by thisday of T --,21.�by
BRIAN J MALONEY BRIAN J MALONEY
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of identification Type of identification
Produced Produced
{Signature of Notary Public-Sta of Florida) {Signature of Notary Pub ic-State ofA�onda)
f' (� n,!, No
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Commission No 7`r'� I Commission No.4� r
err rur Notary Public State of Florida `, y Public State of Florida
Victor G Alterizio > r G RVterizio4292 mission GG 274292+� ' `° Expires 1 10512022 ses 111 5l2
022
REVIEWS FRONT ° PLANS VEGETATION.,,
COUNTS REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17