HomeMy WebLinkAboutPERMIT PAGE TWOSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name -.PAUL WELCH
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address: 1984 BILTMORE ST #114
City: PORT STLUCIE State: PL
Zi p: 34952 Phone78-9888
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: PORT ST LUCIE PLAZA 1,2,3, LLC
Address: 112 PHYLIS CT
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:ELMONT,NY
Zip: 11003 Phone:772-877-1169
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 1 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 playing 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 attornev before commencine work or recording; Your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO I STATE OF FLORIDA
COUNTY OF Lk. -C i CPCOUNTY OF a,- L i_ i -C I
ern to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this r9�- day of �1� 1 2020 by
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Name of person making statement.
Personally Known 'a OR Produced Identification
Type of Identification
Produced -
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(Sig ature of Notary Publi tate of Florida )
Commission No. 66
ip�°r Notary Public State of
MY Commission GG 1o981
REVIEWSI FRONT
I COUNTER
DATE
RECEIVED
DATE
COMPLET
Sworn to for affit,, ) and subscribed before me of
V ,P�h�ysical Presence or Online Notarization
this � day of , J �_ 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
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(Signa ure of Notary Public- State of Florida )
mission No.
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NS VEGETATION
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