HomeMy WebLinkAboutBryan notarized formSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
❑ESIGNERIENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State,
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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 wilt authorize the permit holder to build the subject structure
is in Home
which conflict with any applicable 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 att_Wney before commencing work or re in ❑ur Wce of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA,,,,,
STLw
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
x
Sworn to (or affirmed) and subscribed before me of
Physical Presencor Online Notarization
2' srProm rr
Physical Presencraor Online Notarization
25
this day of 2020 by
this day of septem er 2020 by
Derek Powell
Derek Powell
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personalty Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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Commission No. =lit ,� Commi=sao�.'.= .
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Commission No. 3041tlec t I ational Notary Assn.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20