HomeMy WebLinkAboutPERMIT APP 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: phone:
___- Not Applicable
State:
—Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicate
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 suc
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may aply. h
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 S
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consu
wl der or an attorney before commencing w,or or recording our Notice of Commencement.
Sign
Agent for Owner
STATE OF FLORIDA
COUNTY OFC.
Sworn o (or affirmed) and subscribed before me of
,- Physical Presence or Online Notarization
this day of 202 p by
Name of person making statement.
Personally Known l OR Produced Identification
Type of Identification
Produced
rsignature of Notary Public- State of3tKor
'e
_a }�
Commission No --`, ��„�
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE —
COMPLETED
Ex ftn: Nov.
300od T1n Ii
STATE OF FLORIPA
COUNTY OF_>.
C.;
Sworn �to or affirmed) and subscribed before me of
--Physical Presence or Online Notarization
this day of 202 i' by
Name ofpersonmaking statement,
Personally Known OR Produced Identification
Type of Identification
Produced
re o�rNotary Public- State of
1 ff' _
ion No. L �: J � l .
SUPERVISOR PLANS I VEGETATION I SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
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MANGROVE
REVIEW