HomeMy WebLinkAboutBuilding Permit App, page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
_
City: State:
Zip: Phone
City: State:
Zip: Phone:_
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
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. Notice of Commencement must be recorded in e public records of St.
Lucie County and posted on the jbsite before the first inspection. If you intend to tain financing, consult
with lender or an attoptev befor commencing work or recording vour Notic�f C mmencement.
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Si ature of Owner essee/Contractor as Agent for Owner
S ure of Co actor/Lice s older
STATE OF FLOIDA
STATE OF FLC}>RIDA
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COUNTY OF,T �'C?!�L �i tZ
COUNTY OF[[';S(e4m
Wn to (or affirmed) and subscribed before me of
Sw n to (or affirmed) and subscribed before me of
(`_ Physical Presence or Online Notarization
P ical Pre nee/or Online Notarization
1
this day of , 2020 by
t is day of W 2020 by
Name of person making statement.
Name of person making statement.
Pers ally K wn Produced Identification
Ty e of Ide i icatio
Perso ly Known OR Produced Identification/
Ty e of I ntificati n /j //
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P duced
roduce Gar
My,&v Dornonique Whitehurst
INRY Domonique Whitehu
NOTARY PUBLIC
NOTARY PUBLIC
of Notary Public- F
(Signature y �
(Signature of Notary Public- Stat STATE OF FLORIDA
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Comm# GG254414
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Commission No. CFTC 2 {S@ Igs $/30/2022
Commission No. /�a Tres 8/30/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20