HomeMy WebLinkAboutPermit 2SUPPLEMENTAL CONSTRUCTION LIEN LAVA INPOOM",
ON-'
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicabie
Name: o /i7Per/r2
_
Name:
Address: 441SI S`T Lul',,f
Address:
City: rJ,P r State: _Et-
City: State:
Zip: Phone a / 9--
Zip: Phone:
FEE SIMPLf TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name: 2144 1-9 Lll�_?125
Name:
Address ,k?l L1s c�zc�Ocz�( %L�t'
Address:
city:
City:;,WN
Zip: Phone:
Zip: .5 y 0 !:4 Phone: ,219-- 600- 1703 3
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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Sign ure of Owner/ Lessee ontractor as Agent for Owner
51 Wture of Contractor/License Holder v m
STATE OF P60AZAZ
STATE OF F
v
WQ
COUNTY OF s -- L-oo i S
COUNTY OF S' Q (S
M o-
o
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of cc it
i Physical Presence or Online Notarization
'C Physical Presence or Online Notarization m o
E
I� ay of 2020 by
this _Tay of i��1r1¢ ISEjZ•, 2020 by a z
T
e of person making statement.
Name of person making statement.
�/�
onally Known OR Produced Identification
Personally Known OR Produced Identification
1 of identification
p uced ,DkA 1i4-i5 LA G��47
Type of Identification „
Produced `S l.-C 11,59
E
0
T
�.-
N.. i ature of Notary Public- State of.Fieritta')
(Signature of Notary Public- State of4�.ler-ic#e►)#4,A�AXSnV-
a ►�uC-�S`csylA
mission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Nev. S 20