HomeMy WebLinkAboutbuilding permit application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: X 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 AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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,
accessorystructures,swimming r g pools,fences,walls,signs,screen rooms and accessary 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 commencinp,work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � YY+, { STATE OF FLORIDA Lu,Nq,1
COUNTY OF COUNTY OF
Swor o(or affirmed)and subscribed before me of 5w7O o(or affirmed)and subscribed before me of
Physical Pre nce or Online Notarization Physical Presence or Online Notarization
this 1 day of •u�- .2020 by this day of!&A Jj; ,2020 by
J Pt
LtLL Q.� rt �X
Name of person making statement. Name of person making statement.
Personally Known V-1"'OR Produced Identification Personally Known 11/ OR Produced Identification
Type of Identification Type of Identification
Produced - Produced
tSignajr;of Notary Public-State of Flor' (Signature of Notary Public-State of Florida)
Comm Public State of Florida,Se ) Commission o I)
Sjzejte l l 135736
My commission GG �v�MU fUatafy r ub c:State of Florida
soon GG 13
REVI ZONING SUPERVISOR PLANS ` TA�9'�fi9N�` A'TU MANGROVE
COUNTER REVIEW REVIEW REVIE NA4YAW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 5/6/20