HomeMy WebLinkAboutLassalle P1SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Sandra Lassalle
MORTGAGE COMPANY: _ Not Applicable
Name: David Kruse
Address: 3106 Columbrina Circle
Address: 3106 Columbrina Circl
City: Port Saint Lucie State:
Zip: Phone
City: Port Saint Lucie State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1853 Biltmore Street
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 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.
Signature of Ow e ntractor as Agent for Owner
Signature oV0,,Ctnseolder
STATE OF FLORIDA
STATE O LCOUNTY
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COUNTY OF Scca1C1-tJL1C(e_
The forgoing instrument was ac�kno�wledged before me
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The forgoing instrument was acknowledged before me
this IL day S0fM�'r 20 by
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Name of person making statement
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Personally KnowOR Produced Identification
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Personally Known -/ OR Produced Identification
Type of Identification
Type of Identification
Produced
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(Signature of Notary P teN i 8
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Commission No. o STATE ���} RIDA
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Commission No. —TE OF FI(ORb[�AEP
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xpires 7/29/2023
i es 7 29/20823
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17