HomeMy WebLinkAboutBP page 2, signature pageSUPPLEMENTAL 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 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
WrrH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatyfe of Owner/ Lessee/Contractor as Agent for Owner Signatur�6f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1
i
COUNTY OF d Zug _( r COUNTY OF
The for oing instru ent was cknowledgeq before me
this day of ' 20 , X,(" by
Name of person making statement.
Personally Known OR Produced Identification
Type of identification ? ,gri
Produced Er1I4 Nemoga
LL Commission # GGIO1442
Expires, May 4, 2021
Bonded thru Aaron Notary
(Signatur ofJdotary Public- State of Florida )
Commission No. (Seal)
The forgoing instru ent was knowledge Before me
this day of r 20�y
Name of person malting statement.
Personally Known OR Produced identification
Type of Identificai
Produced
gnature of N
Commission No.
Efik Nemoga
Commission # 13131014,
Expires: May 4, 2021
Public- State'bTrIorida
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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