HomeMy WebLinkAboutApplication (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 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 attornev before commencing work or recording vour Notice of Commencement.
SigNatur'of Own-/ Lessee/Contractor as Agent for Owner Signature of Contra cf'or/License Holder
STATE OF FLORIDA
COUNTY OF -S -V-, LU�-� -�
�Syrorn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 10 day of Sip {tM6c , 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
te
Commission NO.Q2Ca N� =y of Florida
VVMy Cn mmisaon G 292585
Expires 02/11/2023
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA
COUNTY OF 5�-` UUR.
Sworn to (or affirmed) and subscribed before me of
'-j Physical Presence or Online Notarization
this 1Q day of S DJerrb-e-- , 2020 by
bp�r„ e 1 5 S=-VbUs
Name of person making statement.
Personally Knowe OR Produced Identification
Type of Identification
Produced
(Signature oMotary Public- St
ren^ I Notary State of Florida
Commission No. d'�ar'J `h /��"Y"°'il ml� GG 292565
4 w; Expires 02/1112023
SUPERVISOR I PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW