HomeMy WebLinkAboutUpstate 123 Queen Frederika Ct Permit pg2SUPPLEMENTAL 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 AFF)DVIT: 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 attorne before commencing work or recordi your Notice of Commencement.
Signature of Owner/ Lessee/C ctor as Agent for Owner
Signature of Contractor/Lice Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
.
COUNTY OF11
Sw9Tn to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
Ph sical Pres nce or Online Notarization
this day O�
P I Preece or line Notarization
of 2020 by
this day of 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Ty e of Identification
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Type of Identification
Pr duced
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(Si tune of No ar Public- Scat i =) MY COMMISSION 9 GG
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(Signature Notary Public- St
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REVIEW
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DATE
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DATE
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