HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address
City: _
Zip:
one
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 OBTAIN FINANCING, CONSULT
WITH YOUR L FNnFP OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat re f Owner/ Lessee/Contractor as Agent for Owner
Sign8tu of Contractor/License Holder
STATE OF FLORIDA
STATE Of FLORIDA
COUNTY OF kLt6e,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this I O day of 20 L. by
this 1 ['I, day of
, 20,K , 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
(Signatu0e of Notary Public-
(Signatu of Notary Publi
�Jt" " Notary Public State of Florida
Margaret E Montepare
J%r Notary Public State of Floritla
�'
•
Commission No. G al •i}nisston GG 214990
ommission No. o�i
• Marg >tiiontepare
. My C lion GG 214990
9n �pdF Expires 06/05/2022
990
qn Expires 06/05/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19