HomeMy WebLinkAboutScan_0010SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Address:
` Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
this day of 2020 by
City:
Zip: Phone:
Zip: Phone:
i
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 Horne 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 Not -ice 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 your Notice of Commencement.
Kev. 5/b/LU
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA<+, itlp_'
Lw
COUNTY OF +'�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
V'
Swop to (or affirmed) and subscribed before me of
1..'
Physical Prese ce or Online Notarization
Physical Prese ce or Online Notarization
this day of 2020 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
�
Personally Known V✓ OR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
s
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. S
Commission No. eal)
Mary Public State of Florida
r U ris)tary Pubkic State Of Florida
a
REVIE
Suze e I
.c missy
F , f 12/1
n GG 135736
2WNING
SUPERVISOR
-
My Gornm�$sGo GG 135736
PLA�, E9A7NpNf1%.r °S`EA TURTL
MANGROVE
os
REVIEW
REVI
REVIEW
DATE
RECEIVED_
DATE
COMPLETED
Kev. 5/b/LU