HomeMy WebLinkAboutKittredge permit app 2 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :
DESIGNER/ ENGINEER : _ Not Applicable MORTGAGE COMPANY : _ Not Applicable
Name : Name :
Address : Address :
City : State : City : State :
Zip : 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 AFFIDVIT11 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 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 attorne before commencin work or recording our N tice of Commencement .
4S1gture of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORt L , N
COUNTY OF J I -� COUNTY OF
Swor ( or affirmed ) and subscribed before me of Swor�n �ajor affirmed ) and subscribed before me of
_ Physical Pres nc or Online Notarization _ T ysical Prese e Online Notarization
this day of 2020 by tho day of 2020 by
1
Name of person making statement . / Name of person making statement .
Personally Known OR Produced Identification y Personally Known OR Produced Identification
Type of Identification / ` Type of Identificati 1 o
Pr uced r ` v �CX (� c Pro u ed
CAROL SHAMI CAROL SHAMIS
( Signature of Notary Public State f FI a ' „ ' I'
Commission # GG 2 5 gnat re of Notary Public Sat lorida ^ r ssion � GG 255268
S ,_
My Comm . Expires Sep 4 , 2022 , pires Sep 24 . 2022
Commission No . T Sa �., ( SeM)nded through National ft6$0ni ion No. \� L ' Sn National Notary s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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RECEIVED
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