HomeMy WebLinkAboutPSL PG 2SUPPLEMENTAL 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 AFFKDVIT: Application bhereby 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 |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.
|nconsideration mfthe granting ofthis requestedpermit, dmhereby agree that | will, inall 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 lOOWNER: Your failure toRecord aNotice of Commencement may result in paying �twice for
imn m*ent to your property. A �mtice mf Commencementt must be recorded in the public records of St.
and posted onthe 'obsitebefore the first inspectipp-4-Kia dtmobtain financing, consult
*YThJ6wmQ,i,oronat1onnewbefore commencing work orrecorAingVour%�eofCommencement.
Signature of 0�� ��e�f�Ow�r
�~� . .
STATE OF FLORIDA
COUNTYOF-PALm BEACH
Sworn to (or affirmed) and subscribed before me of
1_ Physical Presence or Online Notarization
this 8 day of MARCH 2020 by
Signature
Sworn to(or affirmed) and subscribed before meof
XPhysical Presence cn____Online Notarization
this 8 day of MARCH 2020 by
PAUL MCLAUGHLIN PAULmCLAUGHLIw
Name of person making statement. Name of person making statement.
Personally Known x ORProduced Identification
Type of Identification
joy co
(Signature of Notary Public- 01.d Thru Notary 111—ul
_____
Commission No.
Personally Known x_
IvnanfIdentification
Commission No.
Trif
ORProduced Identification
EXPIRES: May 25,
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