HomeMy WebLinkAboutbuilding Permit Application (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:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
vvvwr-n/ wiv 1 111149-1 UK Hrrwvi I : 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 t e public records of St.
Lucie County and posted on the job e before the first inspection. If you inten
'd t tain financing, consult
with lender or an attorney beforp,196mmencing work or recording your N,ptice ommencement.
Signature of Owner/
as Agent for Owner I Signature of C(;�ftractor/ icense Holder
STATE OF FLORI�� STATE
COUNTY OF -'--tet �—:� COUNTOY OF
Sworn to (or affirmed) and subscribed before me of
Physical Pr Bence or Online Notarization
this (�= day of',{ , 2020 by
Name of person makingstatement.
IV
Personally Known In OR Produced Identification
Tie of Identification
Sn to (or affirmed) and subscribed before me of
hys'cal P -senc or Online Notarization
this ' ay of 2020 by
— h I (Ly".I�_ Erlc�M6 h —
Name of person maki gp statement.
Personally Known OR Produced Identification
Type of Identification
ProAced
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(Signature of N r,"17`�of�n� i%h#G232946 Si nature o. NraQ"
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i = WIN COA4<v11SS10 �# a2 2946
dry: `�; EXPIRES: Jurat 27, 2022;' ;*:
Commission No. ::off° Jhruh.otary(Ib�londerwiters Commission Q Q° EXPIRES: June 272QQ2''''
otaryPubest dbr l'Irs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED