HomeMy WebLinkAboutDOC012121SUPPLEMENTAL 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 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 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 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI A
COUNTY OF 1 e
STATE OF FLORIDA /����
COUNTY OF M '���" d()1� J
The forgoing instrument was acknowledged before me
this day of Ja 20A by
The forgoing instrument was acknowledged before me
this _aday of )l(An 20_ZJ by
CInV S V_. �
�JIt1Gri�C S pi �
Name of person making atement.
Personally Known OR Produced Identification
Name of person makings atement.
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced?1i%0'"W,4 A0%_,)0
Produced,csn,nnN"rpl A!,y.T_
(Signature o N ary PJbl c- tate of h5n )
Notary Public State ol
Kristin Cury
Commission No. I�� ms k41 a� My Commission HH
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i n t re ota ublic �w
Flon a �v � Notary Public State of Florid
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c00iemmi ion No. -sl 1. � Cury
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'9j�np Expires 05/31/2024
REVIEWS
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VEGETATION
SEA TURTLE
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REVIEW
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DATE
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DATE
COMPLETED
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