HomeMy WebLinkAboutMosher Permit App (3)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 commencing work or recording vour Notice of Commencement.
*at� _2� Atli
Sign tur Owner Lesse Contractor as Agent for Owner
ignatur Can ractor/License Holder
STATE OF FLORIDA
COUNTY OF ` I
STATE OF FLORIDA c
COUNTY OF fkkie.�_,-fi—,
0 / ���J
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Sworn or affirmed) and subscribed before me of
Physical Presence or Online Notarization
s day of AdAh 2020 by
thiAU
thi`day ofM/1 - ' 2020 by
Name of p on ma i sfatement.
Name of person making st�atem nt.
/
Personally Known OR Produced Identification
Personally Known A," OR Produced Identification
Type of I tification
Type of Ide ' on
Pro aced �nn l_
Produced
Q014 0% 0% 0% 0% A 0% A 0% fte�
(Signature of Notary Pub[ c- S Worid4ckliryPublic State ofFlixid
{ ' nature of Notary u �
• Pamela Jones
Notary Public State of Florida
r_ , omrtnMM GG 98547
Commission No. (S 08/1 S/2024
Co mission No. r a Pamel
My Com�N GG
i es
a 985470
Expires 06/15/2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20