HomeMy WebLinkAboutreecamper 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Nat Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 paying twice for
improveme to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie CourWand posted on the jobsite before the first inspection. If o intend to obtain financing, consult
with len or,an attorney before commencing work or recording v6uf Wtice of Commencement.
Signatur wner/ Lesse Contractor as Agent for Owner
Signature of ontractor/License H61der
STATE OF FLORIDA
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STATE OF FLORIDA
4- L"Cie-
COUNTY OF
COUNTY OF 3
Sworn to (or affirmed) and subscribed before me of
to
Sw to (or affirmed) and subscribed before me of
to
�/ Presence or Online Notarization
Presence or Online Notarization
this day of �4 f'4!� 202p� by
this - 1- day of 2021d Eby
Gh g. & ick L/ u o,-)
V o C'�- sit
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
MELISSA A GONZALEZ (S nature of Nota u lic- S i *ids) MELI55A A GONZALEZ
(koiftulkf of -Notary Public- StaC'n
tar Public -State of Florida
Notary Public -State of Flori a ' yCommission # GG 139027 y.P :Co fission # GG 139027
Commission No. �a% 139fla) Co
No. =.9 0 ° {.MComm.
mission
Ex es Au 29,2 21 �e`: Expires Aug 28, 2021
y��gBorded
through National NotaryAssn.
BordedtFroughNaticnalNotary sn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU