HomeMy WebLinkAboutSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIONF Cyr 5�iz2 c�
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.
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
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 commencini± work or recordine vour Notice of Commencement.
IOU
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF St Lucle
Sworn to (or affirmed) and subscribed before me of
Pysical Presenc or Online Notarization
this s� day of ff� ( 7_ 2021 by
0-nn �_mQlc,(
Name of person making sta ement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public- State of r
Commission No.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 1-0 ,
Sworn to (or affirmed) and subscribed before me of
_ Physical Pres a or Online Notarization
this day of rc 202F by
Name of persohfnakihd statement.
Personally Known OR Produced Identification
Type of Identificati n
SHELLI LE5 E0iW@ f Notary I' f Florii��l�
State of Florida otary Pub is plq,��G947 3
Commission q U �gi No, �y
My Commis 1 n txplres � 7
March 11 2022
SREVIEWORI PLANS REVIEW I VREV EWON 5 EV EWLE I MANGROVE
REVIEW
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