HomeMy WebLinkAboutbp2I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
R: x Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: x 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 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 attorney before commencing work or recording your Notice of Commencement.
Signature of wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF M V0241 n
.
COUNTY OF t.A�K-P_fiy n
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 2,1day of _5e +MI9 12=. 2020 by
_
this 23 day of Se P40-1 9 2020 by
-mo,#�y,ew 'R-O.LI��YS6rl
iY1a-1"il'�eLJ `{Z0.U��VSOrI
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification YJ
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced nY\Ve tS kA.Q Q JW, _
ProducedDY tUf f S (LCDII F�
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(Signatur'6 of Notary Public- State of Florida)
(Signature Notary Public- State of Florida )
Commission No.GG359 1�41 B (Seal)
Commission No. G6859 9 J 8 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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��Le Commission = GG 3594t8
Commission. - GG 359418
` M} Comm. Expires Jul 28. 2023 M: Comm. Expires Jul 28. 2023
5,.coc lhro,gh Natiora: Notary Assn, aoreee thra,gh National Notary Assn.