HomeMy WebLinkAboutpermit app 2 of 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: '
DESIGNER/ENGINEER: _ Not Applicable
j 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 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 AKATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMOICEMENT."
Rev. 9
Signa! of Owner/ Lessee/Contractor as Agent for Owner
Signatur f Contractor/License Holder
STATE OF FLORIDA
� LUC,'
STATE OF FLORIDA
� L G
COUNTY OF C_
COUNTY OF -,t e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this?—(,o day of f0Q11 20 20by
this2 tw day of l?1 204:, by
Name of person making statement.
Name of person making statement.
Personally Known Ill� OR Produced Identification
Personally Known lle�Ri
Type of IdentificaType
of Identification o p0.v p4e�,," SHARON DEFLORIO
Produced 1P V PUB 4 SHARON DEF! ORIO
a
Produced '�: ''. Notary Public • State of Florida
Notary Public -State of Florida
�,� %�' Commission # GG 041576
Co n,# GG 041576
c„ mm. ) xpires Oct 24, 2020
fovF��P' CC iwt9ct 24, 2020
(Signature of No a P - a r
(Signature of Notary Public- State of Florida )
Commission No. fl�{IS`��a (Seal)
Commission No. U,,4C7{/ S'7 (o (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9