HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: ` Not Applicable
Name:
Name:
Address:
Address:
City: A I F State:
City: State:
Zip: n
Zip: Ph
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name: i I
Name:
Address:
Address: 1 4
City:
City:
to
Zip: e.
Zip: Ph4
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
tL,
STATE OF FLORI A
�mcI2
COUNTY OF ,ffi
___{ue- COUNTY OF
The forgoing instrum nt w s acknowledged before me
this l day of '� 20,� by
The forgoing instrum t wa acknowledged before me
this IS_ day of 1 213A by
ben VIYO I.ti 6 `bW11
Af s^ cow'),'
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- Sta da notary Public State of Flori
ature of Notary Public- Stat
Brian Alan Martin
Commission No. @„�a�$A� ,c 03,07i2023
G`' +a M Commission GG 30932
J(Si
66 J x 20 Notary Public state of Flon
mission No. �(9�8Ir} Alan Martin
• . My Commission
s GG 309328
�'a
Aol Expires 03.07,2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19