HomeMy WebLinkAboutBorregard permit app (3)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _V Not Applicable I BONDING COMPANY:
Address:
City:
Zip: Phone:
Address:
Zip: Phone:
Applicable
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commenciri woa cir recording our Notice of Commencement.
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Signature of ner/ Lessee/Contractor as Agent for Owner
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Signature ofr ntractor/License Holder
STATE I LORIDA � � (('�� /�
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STATE OXORIDA
COUNTY OF C,
COUNTY OF
The fo going instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 2o2i by
this_lLdavof M(i A' �Gf"1 .20o71 by
�cvw\ uSS
6nn'&AsS
Name of person g statement
Name of perso aking statement
Personally Known OR Produced Identification
PersonallyKnown OR Produced Identification
Type of Identification
Type of Identification
Produced I
Produced
,
(Signature f Notary Public-Sta a of Florida)
(Signatu a of Notary Public -State of Florida )
Commission No. � rla5i)�unl ftWdFwnmImmissionNo.
J Keki Moss
o'� (M Pms submF9na
My Cwm.lM GG 309996
S My Ctw, l w GG 309996
ExP�res 03�07/2023
EE Ezpm 03M7=23
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
7RE7VIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17