HomeMy WebLinkAboutBISHOP LOAD CALC1EMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FDESIGER/ENGINEER:Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:Aress:
Address:
State:
City: State:
Zip: Phone
City:
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.
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
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable
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
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
F�Siigni�t
e of Contractor/License Holder
Slgnatur f Owne�Lessee/Contractor as Agent for Owner
/
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _� day of QU LK- , 20_:_ by
this 4 day of --A IC)t , 20 AU by
- Ha C,_
1Gr��e S P w --1- C,,_
Name of person making statement.
.rn ,�_\
Name of person making stat ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
C2�;1 (0
(Signature f Notary Public- State of FI rida)
(Signature f Notary Public- State of Flo ida )
Commission No. cicoa I eaWtary Public State of Flo
iom iission NoL� 1C� l) Notary Public State
aQ Margaret E Monte
a
:° Y4 Margaret E Monte'ar
My Commission GG 214
90 . My Commission GG
orti
an
REVIEWS
FRONT
COUNTER
1
REVIEW
R ISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA T
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.