HomeMy WebLinkAboutBuilding permit app, pg 2SUPPLEMENTAL'
��LIEN LAW INFORMATION:
DRIGNER ENGINEER:
Name:
_Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
bp: Phone
StMe:_
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDINGCOMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Caere
Zip: Phone:
zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: Application is hereby made to amain a permit to dome work and immigration as indicates
I¢niirdat as week or installation has commenced prior to the Issuance OR pvmN.
inconsideration of the panting of this requestetl permit, I W hettby agree that I wilt i0 all repanots, perform the work
in accordance with the appeal plans, Fine Florida Building Codes and 5t Wore County Nneramentx
The following buddlrg primp Indications are exempt from undergmmg a AN canarrinry review: room additions,
accessory structures. swimming Poole fences wall"Irre r Realism,
r
and attuses another nonresidential use
NI WARNG TO OWN ER: Your failure to Record a Nak OfCoentrance ment may reauh In paying twlce 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 Flrst inspection. If you Intend to obtain financing, consult
with lender or an attorney before commencing work or recording voor Notice Of Commencement.
Samuel r Leueer.ontrai as Agent far Owner
slgreture of Comence/t rche aware
STATE OF FLORIDA
STATEOFFLORIDA
COUNWOF�SL yeiii
COUNWOF�CL.
swornto for chronic) and subscribed before me of
sworn to gar aMlmedl and suMcnbed before me OF
d Physica l Presence or Online NimatlOn
� Financial Presence or online Notanffiicn
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Name of person making statemnd.
Name of person OR king statement.
Personally Known rV_ OR Produced ldentirapan_
Persmally Known IC OR RWuatl Identification
Type of demarcation
Type ofld Mfficadoo
Produced
Produced
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETEG
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