HomeMy WebLinkAboutBoreanaz WH pg1SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Nnr Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 folloyring 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
SigSig ur�Owner/ Le see/Contractor as Agent for Owner Sign ture of Contractor/I
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LOae, COUNTY OF Sgij L,,ut
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
VC Physical Presence or Online Notarization Physical Presenc or Online Notarization
this 2L day of AlVe6 rr- 2020 by this ` SS day of A cr��+ 2020 by
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Name of person making stateme . Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
4Produ
(Si ure of Notary Public -State of FI orida )Dyla c,,,,sWPtwVA
Commission No. G l Sl TARYPUBLIC
STATE OF FLORIC
Convng GG933282
xpues 171
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW I REVIEW
Personally Known OR Produced Identification .�
Type of Identification
Produe �� xr+j L'C*,
(Sigifffure of Not4 Public- State of Florida) Dylan CMsto"
Commission No. G6"31$ Z NOTSAMSTARY
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PLANS VEGETATION SEA TURTLE MAN GRExpires IOVE
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REVIEW REVIEW REVIEW REVIEW