HomeMy WebLinkAboutBuilding Permit Applicaton, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEtii: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: T Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: , Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 consu It with your Horne 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 ienoer or an attomev before commencine worK or recoralne your Notice OT LOmmencement.
Signature of CWnerl Lessee/Contractor as Agent for Owner Signature efito ntractor/Lice nse Holder
STATE OF FLORIDA
COUNTY DF�—
Swoy+fito (or affirmedl and subscribed before me of
✓✓ Pftysical Pres nce or Online Notarization
this day of e.e— 2020 by
STATE OF FLORIDA cc
COUNTY OF c3i- W6 C-
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this l day of Si���r 2020 by
i"t5 tJ� u c'sr— . l
Name of pers n making statement. Name of persdn making statement.
Personally Known OR Produced Identification
Type of Identification
Prod used _
tSig atore of Notary Pablic- St rtullud
v BiiW4f]Y Dk�tIELS
Commission No. '� � wSsbN *GG182132
DiPiRES: FFB 04, 2W2
rs� RBanded thrutjO is[ Stale InWfarnce
REVIEWS FRONT I ZONING
COUNTER REVIEW
IVED
COMPLETED
Personally Known I` OR Produced Identification
Type of Identification
Produced
(SigArfure of NotTry P ic- State of Florida j
Commission No.
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW REVIEW
(SWDY DAWELS
My CgyM*$ION #GG182132
WIRES: FEB 04, 2022
REVIEW I REVIEW