HomeMy WebLinkAboutApplication 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: ____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 apermit 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_"
Geary S Adams----,
Geary S Adams
Signature of Owner/ Lessee/+contractor as Agent for Owner
Sign aturV:TContractof/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _Indian Rivar
COUNTY OF Indian River
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of AUguSt 202Q by
this _ day of August 2020 by
Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
—
(Signature of r4mry Public- State of Florida)
(Signatur otary Public- State of Florida )
Commission No. (Seal)
Commission No. _' (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
tFRV P', MICHAEL ADDEO �.......
_`�•''"�'� MICHAEL ADDED
MY COMMISSION # GG035606
y. MY COMMISSION # GG035606
EXPIRES October 04, 2020 9',
?'aWF1 EXPIRES October 04, 2020