HomeMy WebLinkAbout2nd Page Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City,
Zip: Phone:
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 Counmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conty Ict 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 1 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
2"ARIAG TO OINJIM YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TMM FOR WROYENIMM TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FINST NSPECTKW F YOU HMM TO OBTAIN FMJ NOIIG, CONSULT
WITH YOUR LEADER OR AN ATTORNEY BEFORE RECOIDBIG TOUR NOTICE OF COIrIB1C8 ff 0
of
as Agent
of
STATE OF FLpQII����D STATE OF FLORIDq
COUNTY OFM_ Milo', P . COUNTY OF; �I ' to Is'
The for oing instr�{ment was acknowledged before me The fo�?ing instr nt was acknowledged before me
this 7dayoff1tQt 20,IL by thisday of t1L .2iZby
Aurfk,.�kF. tripp A�IJnrlrr ulheArd
Name of person making statement. Name of person making statement.
Personally Known I,/ OR Produced Identification Personally Known Z OR Produced Identification
Type of Identification I Type of Identification
KRYSTAL PATTERSON
Commission / GG 3/3982
Expires July 28,2023
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Bruce D Pederson l
Commissio�n;Noo. ex rw G, 903044 mmission No. s, (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW