HomeMy WebLinkAboutBuilding Permit App, page 2SUPPLEMENTAL 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
BONDING COMPANY: 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 thi jobsite before the first inspection. If you intend to ob in financing, consult
with le der or an attorney be ore commencing work or recordipg your Notice of Co encement.
i nature of Ow r essee Contractor as Agent for Owner
Sig�Ature of Con `ac r/Lice s'e Holder
STATE OF FLO- IDA� �/
COUNTY OF f,,aWJ,.,;N
STATE OF FLORIDA
COUNTY OF�(Gl /�- (
�or� to (or affirmed) and subscribed before me of
to (or affirmed) and subscribed before me of
Ph cal Presence orOnlineNotarization
this �PL day of &� AKpLs� , 2020 by
sical Presence or Online Notarization
this l4� day of ���1� 2020 by
Name of person making statement.
Name of person making statement.
Perso-Dalnown _ OR Produced Identificatiol�
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f th A Domonique Whitehurst
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Personally Known OR Produced Identificatiox-
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(Signature of Notary Public, f ��� OF FLORIDA
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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