HomeMy WebLinkAbouthvac (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:L Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Na me:
Address:
Citv:
Zip: Phone:_
State
MORTGAGE COMPANY: Not Applicable
Na me:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: -Not Applicable
Name:
Address:
City:_
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 commencine work or recording your Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA l
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STATE OF FL
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COUNTY OF lL
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COUNTY DFORIDA ,���
Swoy�i to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
V Physical Pres nce or Online Notarization
this day of by
Physical Presence or Online Notarization
this i day of 60- 0. °i�9�y
Name of person making statement.
Name of person making statement.
Known tl� OR Produced Identification
Personally Known OR Produced Identification
Personally
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida );
(Signature of Notary Public- State of Florida )
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Commission No. (Seal)
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DATE
RECEIVED
DATE
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Rev. 5/b/20