HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
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 Horne 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 our Notice of Commencement.
Signatur Owner/Lessee/Contra as Agent for Owner Signature f Contractor/License HoWr
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFSIL.c- COUNTY OFSIL�-L
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Preseiace oLx Online Notarization Physical Prese Ice or x Online!Notarization
this 241h day of �� 2020 by this 241h day of �-T?, , 2020 by
JASON E.PAFUSF
}ASOv L PARfS7=
Name of person making statement. Name of person making statement,
Personally Known x OR Produced Identification Personally Known X OR Produced identification
Type of Identification Type of Identification
Produced Produced
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(Signature of otary ublic-St tllf
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Commission No.
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REVIEWS FIR � G• _PERVISO PLANS V N�cr�3'
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COL!# R�d� PRE �fll �,•: IEVIEW REVIEW � If�l�ayc :, REVIEW
DATE -o
RECEIVED �'�i'gi ' Under+'` .•� ��� y ••..
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DATE I��HHIIt11N��
COMPLETED
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