HomeMy WebLinkAboutDemolition application page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: Name
Address: Address -_ -
city: COV7 — —T — —
Zip Phone: Zip: Phone -
OWNER/ CONTRACTOR AFFIDVFT: Application Is hereby made to obtain a permit to do the work and installation as indicated
I uerbfy that no !crock or installation hascommenced prior to the issuance of a permrt.
St. Luck' County makre no representation that Isgranring #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 c❑vendnls that may resZn(,t or prohibit such
structure Please consult with your Home Owners Associabon 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 buil&% permit applications are exempt from undergoing a full connrrrency review room adds Lions,
accessory stroebites, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-resideritial uu
WARNING TO OWNER: Your failure to Record a Notice of+Commetcement 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 lenderor any)before commencing work or recording vour Notice of Commencement.
i�
Sigrt urmofOwner/Lessee/ContmctnrasAgent for Owner Sign# re of Contractor/License holder
STATE OF FLORIDA� STATE OF FLORIDA
COUNT1f OF ���.L_r _ COUNTY OF rTM
Sworn to for affirmed! and subscribed before me of
_ Physical Presence or Online Notarization
thik day of "O by
flame of person making statement
Personally Known t/ OR Produced Identification
Type of Identrfrcaaan
(Signature of Ni
Commission No.
REVIEWS
)ATE
IECE IVED
State of Florida
}� LOPEZ
Y t GG 294971
EXPIRES: January 24, 2024
Sworn to for affirmed) and subscribed before ire of
!Physical c or Online Notanzation
this day of r 202a by
rJ
.L'7�
Name of n malurg sta ernent.
Personally Known L-' OR Produced Identification
Type of Identification -
Produced
(Signature o Public- State of Florida)
Commission No_ (k! 1SIdG7 / Owm - _
FRONT- - - ZONING SUPERVISOR PLANS VEGE fATION
COE1NfEIl REVIEW REVIEW REVIEW REVIEW
REVIEW
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