HomeMy WebLinkAboutBuilding permit app, page 2 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDIN OMPANY: 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 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 our Notice of Commencement.
Signature o wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIRA STATE OF FLORIDA
COUNTY OF JWOLL0• , 24'✓-k COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
4---Physical Presence or Online Notarization Physical Presence or Online Notarization
this 2- —day of 2020 by this day of .2020 by
Name of person making statement. Name of person making statement.
Personally Known FOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sig ature of Not4e Publ c-Stat .. BRANDYGWtDI igna re Mlle q�l Public
' CO(IAMISSION 351240 �= Commission # GG 270079
Commission Noe IIRES�Se�emberlm io o;� My Commission %�gq dgs
BWidedThiuNota�yRabli.0 91YItR0ri O.Mber 22, 2Cf2
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED F__I
ev. 0