HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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 l 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 IMPROVE NTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JO SiTE BEFORE THE FIRST INSPECTION. IF YOU INTENvirTo OBTAIN FINANCING, CONSULT
WITH YOUR LENDER RAN ATTORNEY BEFORE RECORDING YOUR NOTICE Ot COMMENCEMENT."
Signature of Owner/ Less e2/Contractor as Agent for Owner Signature of Contractor/ iconse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Z�_jej&.J jejVIfe COUNTY OF_L .011A/ 16.
The forgoing instrument was acknowledged before me The for Ding instrument was acknowledged before me
this a day of... 01{ �fc' t L 20_c,�y this I day of A f Q( L 2gaL by
,I'll
Name of person making statement. Name of person making statement.
Personally Known S!� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Si at of Notary Public- State off FI (Signa e of Notary Public State of Florida
4 f ` r Nota Public SW e
Lsf� {�'s c°b fsio No. Wy* Narary Pu
Commission No. Randy G Bias Randy G
,p< My Commission G 302181 4 My f)omm
or
Expires 02/141ZD 3....
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
of Por
3021E