HomeMy WebLinkAboutBuilding Permit App SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: x Not Applicable
Name:Nu0'W n5,reAn g Name:
I Address:=11634swR..« s, Address:
City: PDnStL.oe State: FL City: State:
Zip: JA9,57 Phone:-6z"g,s Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: x Not Applicable
Name-.$— 50 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
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 wdl 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 attorney before commencingwork or recording our Notice of Commencement.
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Signature of owner/Lessee/Contractor as Agent far Owner Signature of Co r cense Holder
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STATE OF FLORIDA STATE OF FLORIDA / ,
COUNTY OF Seim� L..Vr e' COUNTY OF�v
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Sworn to(or affirmed)and subscribed before me of Swor�to(or affirmed)and subscribed before me of
_kt�'Physicai Presirict or Online Notarization ✓ Physi al Pre nce or Online Notarization
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this 22day of _, 2020 by this y of 2020 by
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' 1�i11�a �•�r,�l�r,-- �� ���
Name of person making statement. Name of person ma1king statement. 4 "
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Personally Known OR Produced Identification Personally Known V____0R Produced Identification
Type of Identification Type of Identification
Produced Produced
y _ ate•
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(Signature of N t Public-State of or =a:
� :ON
e�,:al�atu of Not ub Ic- a of F Ida�Commission No.
E»Is0711 iss1 No. {seal) ,,�irllsns�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20