HomeMy WebLinkAboutApplication (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: FBC Plans & Engineering Services, Inc.
Address: 8272 Abbott Station Dr Unit 101
City: Zephyrhills State: FL
Zip: 33542 Phone 813-788-53314
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City
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 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 attorney before commencing work or recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Palm Beach
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 19th day of August 2020 by
Michael Sonsini
Name of person making statement.
Personally Known '—
X
Type of Identification
Produced
J`y _
(Signature of to
Commission No.
STATE OF FLORIDA
COUNTY OF Palm Beach
SW
rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 19th day of August 2020 by
Michael Sonsini
Name of person making statement.
OR Produced Identification Personally Known OR Produced Identification
Type of Identification
Produced
—
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