HomeMy WebLinkAboutslc permit notaryf SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 OBTANY FINANCING, CONSULT
WrIrH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
JJ_'_75__
Signature of Ow er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�`
COUNTY OF _ . ( P
r
Signature of Con ractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this � day of 20 ZO by this day of . 20_ by
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
I '
Aft —
(Signature of Notary Public- State of Flor '" ature o tart' Public- State of Florida
� g� LAURA R. CUBB�
Commission No (� (p ell „1Commission#GG022076
Expires October P."lly'tDssion N (Seal)
��.• Bonded TMuTroy F6n hmw $*N57018
REVIEWS I FRONT ZONING
j COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR PLANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW