HomeMy WebLinkAboutBuilding permit app, page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORMATION:
DESIGNER%ENGINEER:
Name:
of Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:ddd�
Zip: Phone
State:_
City:
Zip: Phone:
state:_
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
CiN:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: APWimmn is hereby made to obtain a "MR todo the wore and Installation asindicated.
I rrtify Mat no work or installation has canmenced prior to the Issuance of a ped
nerebygreetnat w111, 1n all reacted perform the Pak
in accordance wiapplications; a on a BuildingtArraignments;.
The follorgard Poll pard
accessary normal swimming Is fr n acce dal and
WARNING TO OWNER; aine Your failure to Record a Notice of Commencement may result In paying thalsor for
Improvements to your property. A Notice of Commencement must be recorded In the public records of St.
Lurie County and posted on,the jobsite before the Hirst inspection. If you Intendtoobtain financing, consult
poll "ad
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nature orawner/LesseeTwnpaanr as Aaen for Needed
reof onna Raceme Holder
STATE OF FLORIDA
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STATE OF FLORIDA
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COUNTYOF .i/
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