HomeMy WebLinkAboutBuilding permit app, pg 2f SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -I
DESIGNER/ENGINEER: X Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:--..-..
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Applicable
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 he 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Physical Presenc or Online Notarization
this day of 2020 by
U6.-,,,ee IL
Name of person making statement.
Personally Known
Type of Identification
Produced
OR Produced Identification
(Signature of Notary Public- State of Florida )
Com I)
Sys ru.I Notary Public State of Florida
. f `� Suzette Ritchie
� )&,� L 6o.,-L,
Signa re of Contractor/License Holder
STATE OF FLORIDA t
COUNTY OF
PSwor to (or affirmed) and subscribed before me of
hysical Prqje n ce. or Online Notarization
thi�day of 2020 by
Name of person makingstatement.
Personally Known V/OR Produced Identification
Type of Identification
Produced,
to I) ^ 1
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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