HomeMy WebLinkAboutApplication 2')U'VK `_M'tw t f.AL CONSTRUCTION LIEN LAW [
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: - Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
of Applicable
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 m result in paying twice for
improvements to your property. A Notice of Commencemen ust e recorded in the public records of St.
Lucie County and posted on the jobsite before the first insp ction. y u intend to obtain financing, consult
with lender or a me before commencing work or re r In r Notice of Commencement.
Signa t e of Owner/ Lessee/Contractor as Agent for Owner
STATE OF NTY OF FLORID
Q
SW n
CO7to (or affirmed) and subscribed before me of
Physical Pres ce or Online Notarization
this M day of 9 2020 by
1 li r� �W/Q e 0�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Pr
Notwv PUNIC Stale of F10 ft
Johnnie B Griffin
13WS
(Si at re
Zotary u atci#�i6t
Commissi No. (Seal)
REVIEWS I FRONT I ZONING I SUPERVISOR
COUNTER I REVIEW I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature ofK:ontra /License Holder
STATE OF FLO
COUN OF
Sw rn to (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization
this �/ day of (� i�. 2020 by
AL'00 I it pe -0 I ."
Name of personm'akingstatement.
Personally Known ti(/ OR Produced Identification
Type of Identificati
Produced
FiorMs
Johnnie B GOWN
AMComrnisNw GG 136375
Commission iib. (Seal)
PLANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW