HomeMy WebLinkAboutBuilding Permit App (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: T Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
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 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 INTEPATO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR ANXTORNEY BEFORE RECORDING YOUR NOTICE�OFrCOMMENCEMENT."
Signature of Owner/
as Agent for Owner 9 Signature of
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF r' COUNTY OFn/
The forgoing instrument was acknowledged before me
thiscpday of _i -ice'}' 20ice by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signa a of Nota�ryj Public- State of F ri a)
Commission No.��% �% Ids-' :
7Rndy
G 'i� ssac
3 G Bias
REVIEWS I CO ONTER REVIEW S REVIEWO
DATE
RECEIVED
DATE
COMPLETED
Theforgoing instrument was acknowledged before me
this!Uday of ,:yrs Y 20,;?,L> by
Name of person making statement.
Personally Known�..._._OR Produced Identification
Type of Identification
Produced
Al
(Signatur of Notary Public- State of r Notary Public St
a e�
Idafi'r C, Rias
° i�fl$RISsi n
aFsa+ Ex io U214�21
302181 — — — — -
EGETATION
REVIEW V REVIEW REVEWLE MREV EWVE
181