HomeMy WebLinkAboutslc 3.27.20.1SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
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 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 cion -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 SITE 13EFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YQbV--ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCFMFNT'_"
d =V. L/ // 17
Signature o ontractor/License Holder
Signature of weer/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF-
COUNTY OF 5f Gum e,
The forgoing instrument as acknowledged before me
this day �� - ` 1t�y
The forgoing Instr Tent w s acknowledged before me
�
of 20
this day of DX_ 202A>by
Name of person making statement.
Name of person making t tement.
Personally KnownR,BM duced Identification
Personally Known OR Produced Identification
Type of Identificati6r •, ; q?�„ Eflk Nemoga
Commission
Type of Identification
Erik Nemoga
Produced # G13101442
+
Produced ^Ommissl0n GG101
Expires; May 4 2021
Bonded thru Aaron Notary�Nd�'
_A.
Bv�1pd thr�Aaron No
Signature ofrq6tary Public- State of Florida)
-(Signature of Not ry Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
.
d =V. L/ // 17