HomeMy WebLinkAboutApplication (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION; I
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip:
Phon
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 holderto 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
211 ?4A.,L_ -
Signature of Owner/ Less o tractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF S
The forgoing instrument was acknowledged before me
this __a day of 20 any
Name of person making statement.
Personally Known OR Produced identification
Ty ion
Produced
(Signature of Notary P bli State oT-Florida )
Commission No.Q °1 a+Yl5� (Seal)
REVIEWS FRO
COUP
DATE
RECEIVED
COMPLETED
Signature of
Holder
STATE OF FLORIDA �V Gl �,
COUNTY OF 5�
The forgoing instrument was acknowledged before me
this day of bZt' 20al-Cby
[�b� ZZratk0%C_ k.
Name of person making statement.
r rsonaZ-noKOR Produced Identification
Type ification
Produced 0 N
o �
(Signature of Not blic-State of Flori
a
Commission NoQQ 113-15�1_ Seal
PLANS VEGETATION I SEA TURTLE
REVIEW I REVIEW REVIEW