HomeMy WebLinkAboutScan_0005SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
-X Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Na me:
Address:
Not Applicable
BONDING COMPANY:
Name:
Address:
JLNot Applicable
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
which is in conflict wit 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 attorney before commencing work or recording vour Notice of Commencement.
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Signature of Owners/ LLessee�/_Coonntrralcctoer Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA -&
STATE OF FLORIDA
COUNTY OF ,_��
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�5w n to (or affirmed) and subscribed before me of
S or to (or affirmed) and subscribed before me of
hysical Pres nc or Online Notarization
Physical Presence or Online Notarization
this day of 2020 by
this J_ _ day of 2020 by
Name of person making s tement.
Name of person makings tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida ).
Com te , tsof F4,,idjSe )
Commission
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r° Suzette Ritchie*
r Notary Public Slate of Florida
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Suzette Ritchie
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REVIEW
REVIEW
DATE
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DATE
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