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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zi p: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ` Not Applicable
BONDING COMPANY: Not Applicable
Name:
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.
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Less/Contract-or as Agent for Owner Sign ture_of Contr for icense Holder
STATE OF FLORIDA
COUNTY OF I" I
Sworn to (or affirmed) and subscribed before me of
Ph sical Presen a or Online Notarization
this
rday of 2020 by
`i�0�er4 lteym,25rs71
Name of person making statement.
Personally Known _ OR Produced Identification
Type of Identification
Produced / I
P e
(S'igfiatureLof Notary Public- Stat G c
Commission No. C 3Caa
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Notary Public State of f
Melissa L Butterfield
Wy Commission GG 34
Expires 0211412023
STATE OF FLORIDA
COUNTY OF FL
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
this 24 day of rune 2020 by
RobertThompson
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
e
(r��Ign tora of Notary Public- St e a Qri
,, i qc tart' Public State of .
x° r Melissa L Butteffiatd
Om ssion No. CG302065 c �mmissinn GG 30
a°4 E,.aires O211412023
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW