HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; Not Applicable
Name: MORTGAGE COMPANY: Not Applicable
Address: Name:
City. Address:
State: City: State:
Zip: Phone Zip:
FEE SIMPLE TITLE FOLDER: Not Applicable BONDING COMPANY:
Name: — —Not Applicable
Address: Name:
City: Address:
City:
Zap: 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 instal€ation has commenced prior to the issuance of a permit.
which is inoco 1 lict with any pp€icableiHome aOlwners Assoe ationl ru es,authorize
by aws or and co elnanots that malytl esti �t p�� pr fjibit 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 resulgt�r� your paying twice for
improvements to yau'r roperty otice of Commencement must be recorded`anld poste the jobsite
before the first inspection. If ydu intend to obtain financing, consujt [ th lendl6r organ at$orne before
commencin work or recordi'n auk Notice of Commencement. /
Signature of 0`ner[ Lessee/Contractor aS Agept for Owner
STATE OF FORIDA
COUNTY OF
The for oing�instru nt was ac4 nowledg fore me
this da of 20y
Name of person making statement
Personally Known /�_ OR Produced (dent' c 'tion
Type of identification
Produced_
: / f` ._
ignature of
CommissionO.nY�Ler_ Notary Public
r_ My Commission FF °81647
9oFp� Expires 05/2812020
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of Contrictoi
r;
STATE OF FL IDA
COUNTY OF /r
The oing fistru en
this — day of
nse
M� k lck wledg fore me
20�y
Nae of person making statement
Personally Known x: OR Produced Identificati
Type of Identification
Produced
Signatureof Nota a I'c-S f I r'
Comm°rssio �r a�eF Notary Public State of F rid
�aboni kbea�)
My Commission FF 981647
1j of clop Expires 0512812020
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