HomeMy WebLinkAboutAgnewP2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Eden Agnew
MORTGAGE COMPANY: _ Not Applicable
Name: David Kruse
Address: 10851 S Ocean Drive Lot 153
Address: 10851 S Ocean Drive Lot 153
City: Jensen Beach State:
Zip: Phone
City: Port Saint Lucie State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1853 Biltmore Street
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 your Notice of Commencement.
Signature of Own e ee/Contractor as Agent for Owner
Signature ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF LAJCk e
COUNTY OF C_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 9"clay of N04e%,)wxf 207?JL by
this}`I day of 20 ZO by
Name of person making statement
Name of perso making statement
Personally Known �_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
L
-
AL
(Signature of Notary Public- State of Flor a)
�'F ry
(Signature of No7A�STATd,'bf@OLORIDA
qs, naechel Ferry
NOTARY PUBLIC
Commission No. NOTARY WBUIC
Commission No.
= STATE OF FLORIDA
Coma* GG360087m
Com# GG360087
Expires 712912023
Expires
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17