HomeMy WebLinkAboutbuilding permit (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone
State:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
VNot Applicable
Address:
Address:
City:
Zip: Phone:
City:
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,
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 commencing work or recording your Notice of Commencement.
1 'i4� hL
tgnature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF F
OUNTY OFORIDA
Swo (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this,aVday of. r 2020 by
Name of person making statement.
Personally Knowny OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Com rri'j!s4f ha iiilb�k Of F londa(Se
�v Notary u Q taw
Suzette Ritchi nn 135736
da.'�
Signature of Contractor/License Holder .
STATE OF FLORIDA <4
COUNTY OF 0
Swo'�n,eo (or affirmed) and subscribed before me of
V" Physical Presence or Online Notarization
this day of 2AW by
Cv�—t-2
Name of person making statement.
Personally Known i'� OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. al)
og to, Notary Public State of Florida
'
Ex—a..1211212
21
uze en
GG 135736
COUNTER
REVIEW
SUPERVISOR
REVIEW
Ltr
PLAE
REVIE�
iAJzr122�A
TURTLE
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU