HomeMy WebLinkAboutbuilding permit app page 2I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City-
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zi p: Phone:_
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone: -
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated,
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 Comy and posted on the jobsite before the first inspection. If you intend tq-0tain financing, consult
with le er or an attorntey before commencing work or recorAn"our Notice of mmencement.
i -
nature of O e essee/Contractor as Agent for Owner
i ature of Co ra r/License Holder
STATE OF FLORIDA
STATE OF FL IDA
COUNTY OF L
COUNTY OF
Swor (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
V Physical Presence or Online Notarization
this day of act-Otic,e r , 2020 by
this day of O.�ta to 2020 by
Le Aac W
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X ('A `C r-eZ
r r\,exr,1E n'e_-
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification X�
Type of Identification
Type of Identification
Produced dig p620-000-76-324-0
Produced dig p6204)00-76-324-0
Soto
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NOTARY PUBLIC
# � Y PUBLIC
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(Signature of Notary PWiIC11 Fj FLORIDA
[Signature of Notary Public-W 6 GG315M
5963
Commission No.
Expires 3/25/2023
xpirl}'5J2023
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.