HomeMy WebLinkAboutScan_0011SUPPLEMENTAL 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:
_XNot 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.
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 Assodiation 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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev betore comme
_V -
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA s,
COUNTY OF
Sw9rfn to (or affirmed) and subscribed before me of
V Physical Presence or — Online Notarization
this Ill day of 2020 by
Name of person making statement.
Personally Known L OR Produced Identification
Type of identification
Produced}
(Signature of Notary Public- State of Florida )
Commission No.
r
(Seal)
Florida
Notice of Lommencement.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF -- -_
Swo3'to (or affirmed) and subscribed before me of
1/ Physical Pre ence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Suzette R cnie r° "r Suzele Ritchie
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FLII '2 E I EVIEW REVIEW Exp' 5 1 VIEW
DATE
RECEIVED
DATE
COMPLETED