HomeMy WebLinkAboutJACKSON PERMIT APP1SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Name:
Address:
City: State:
Zip: Phone:
City: State:
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
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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
SignaW of owner/ Lessee/Contractor as Agent for Owner
Signat Tfntractor/License Holder
STATE OF FLORIDA
COUNTY OF T1 . ! -_� �_ it
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 1 akday of J 01,i , 20,Zl by
The forgoing instrument was acknowledged before me
this I +day of ju � Lk, 20� by
3cm S C..
1
Name of person making sta ement.
Personally Known " OR Produced Identification
Type of Identification
Produced
Name of person making statement.
Personally Known " OR Produced Identification
Type of Identification
Produced
f[ . '�2t
-M , C 'i �c .
(Signatur f Notary Pu
Notary Public state of Florida
Mar a��,,eCt� E ��l1ontepare
Commission No. My c%h n GG 214990
• 4a Expires 06/05/2022
(Signature f Notary Publ',t�„of NtS�AGb is State of Florida
� Margaret E Montepare
My e�n GG 214890
Commission No.�3ly�i Expire 2a22
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