HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAIC INFORMATION:
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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: dame:
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,wails,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 rgcorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
comme):King work or recording our Notice of Commencement. '
Signs ure of Owner/Lessee ontractor as Agent for Owner Signature of Contractor/License Hotifir --
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L0 Ifs COUNTY OFThe forg ing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
thisday of���20 by this Lsu� day off 20 Z I by
L -Ze
(Name of person acknowledging I (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known �QR Produced Identification Personally Known I/ - OR Produced Identification
Type of Identification pe of identification --
RY P� CHR€STINA MARIE SALTO R aduted CHRISIINA MARIE SALTOS
Produced zi" W° MY cOMM15Sm#GG270 O7
EXPIRES:OCT 23,2022 _ Y CQMMISSION#GG270307
Commission No. �� 3 L mmission No. —7 U _ � s:OCT 23,2022
*ded through 1st State Insur n w Bo edt�Igh 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014