HomeMy WebLinkAboutRing permit app pg2Pero%; � 4P Za0,4-- C) 6-'R
SUPPLEMENTALCONSTRUCTION LIEN LAW 11
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
ZIP' Phone:
IFORMATION.
MORTGAGE COMPANY: ` Not Applicable
Name:
Address:
City: State:
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 certlfy 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 andcovenantsthat 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 .DOB SITE BEFORE THE FIRST INSPEC'T'ION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEINEN' n
Signature of Owner/ Lesse ontrac or as Agent or Ow
STATE OF FLORIDA
COUNTY OF
The forgoing instru ent was acknowledged before me
this 3 G day of �202—,-D by
L r)
Name of person making statement.
Personally Known v OR Produced identification
Type of Identification
p„gnawre or Notary Public= State of FI C LL
CC�b5��2 NOTARY
Commission No. I STATE OF
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OFA_
The forgoing instrument was,acknowledged before me
this,3 dayof�. 20Z_(':+ by
AM
,t em o
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(SignatZre of Notary u'bli
No.
FRONT I
ZOING
REVIEWS I
COUNTER REV! W S REViEWUPEVISORI ]PLANS REVIEW I VREVEWON ISEREVEWLE
OF
Ea OMS
MANGROVE
REVIEW