HomeMy WebLinkAboutSL-Permit-App-GATE-HERITAGE-Page-2SUPPLEMENTAL 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 BONDINGCOMPANY: Not Applicable
Name: Name: `
Address: Address:
City: City:
Zip: Phone: Zip:phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made toobtain a permit to do the work and installation as indicated.
I certify that no work er installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorise thepermit holder to build the subject structure
which is in conf�ict with any applicable Home Owners Assovatmn rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deetl for any restrictions which may apply.
In consideration of the granting of this requested permit, l 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 concomenty review: room addiFons,
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 tile jobsite before the first inspection. If you intend to obtain financing, consult
with lender oran attor[LMbeforecommencin¢ work orrecordingour Notice of Commencement.
SnOwner/
�
signor a Lessee/Con[ or as Agent fa
Owner
Signature of Contractor/license Hold
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF
COUNTY OF 5-1-. li,.UCI e
: Swum lo(or affirmed) and subscribed before me
Sworn to for affirmed) and subscribed before me of
Ph -zeal Presence or Online No tariza[i
this day of_, 2020 by
c�R�
4`�a
Physical Presence or Online Notarization
thisday of2n2n by
p-
Name of person making statement, s,.e,
Name of person making statement.Pers]
llyId Known OR Produced ltlentifica e.
Personally Known_X__ OR Produced ldentiFlgtlo $ 1
Type of Identification
Type
'✓'
Type of Identification p
c
Produce j=1_ �n �il(n�-�-`(�O-8�
Produced 1€€+33€
(Signature of Notary bli-State of i6iledar) (Signature of Notary ubl -State of flailld.I
�G
Commission No.y� (Seal) Commission No. (11513 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE j MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
—
RECEIVED
DATE
COMPLETED