HomeMy WebLinkAboutpage 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable MORTGAGE COMPANY: X Not Applicable
Name:
Address:
State
City: State:
Zip: Phone:
Not Applicable � BONDING COMPANY: A 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 a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assbciation 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 guying twice for j9
improvements to your property. A Notice of Commencement must be recorded in the public records of St. 'I
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financine. consult H
with lender or an attornev before commencing work or recordiniz vour Notice of Commencenlern. y
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA Ltj���
COUNTY OF
COUNTY OFLC`Q� _
Swor o (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
hysical Pre enc Online Notarization
this ' day of 2020 by
Name of person making statement.
Name of person making atement_
Personally Known � OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced,1
Produced
(Signature of Notary Public- State of Flori }
(Signature of Notary Public- State of Florida }
Corn o. Pub li0State otFtoridat (S l)
Commission No. (Seal)
gar Pt,
Suzette ie
GG 135736
Gammisgion
Nei
REV j
LrxQires
ZONING
SUPERVISOR
PLANS
$ Notary Pub
�i��y,�LE
c State of Florida
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
Ile IEftires121212
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20