HomeMy WebLinkAboutApplication 2SUPPLEMENTAL 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 TITLEHOLDER: _ 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 attornev before commencing work or rerorrlin¢ vour NntirP of CnmmPnrPmPnt
Signature Ow Lessee/Contractor
i
of er/ as Agent for Owner
Signature of Contr or/License Holder
STATE OF FLORIDA I
�
STATE OF FLORIDA
COUNTY OF u Cie
COUNTY OF
Swoto (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization
this day of ` — 202# by
Physical Presence or Online Notarization
this day of a2021 by
f�
Name of person making statet.
Name of person making state ent.
Personally Known OR Produc o Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification p .1`
Produced
Produced
(Signature of Notary Pubtie= S� . ` rida Erik Nem a Og
Commission #GGIO1442
(Signature of Notary Public- lorida) Erik Nem sp
Commission No. SeaIXpIrES: May 4, 2021
Commission No. .*CY,Ion #� GG101042
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20