HomeMy WebLinkAboutHaug pg2SUPPLEMENTAL 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 TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not 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 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 recording vour Notice of Commencement.
Signature of er/ Lessee/Contractor, @$,own9r
STATE OF FLORIDA P' '"=e of Ankara )
COUNTY C►L3 of Ankara )ss
E^,bg,Sy nr the United)
States of America)
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
t is j Z day of I! r 202]Lby
Contractor
STATE OF FLORIDA
COUNTY OF »A W'r 1?4
Sworn to (or affirmed) and subscribed before me of
L/4hysical Presence or Online Notarization
thls �^ Eay of ^n AfZ-C_N 2626 y
2cLr
)n .y H,d son �U,nr; 8eA 000 A-) -3 4-or.?G-rf
Name of person making statement. J Name of person making statement.
Personally Known OR Produced Identification ^ Personally Known OR Produced Identification ✓
Type of Identifica ion Type of Identification
Produced A U (f 1Ulaziz Sal fr o d u c e d 7L_De4N'6fr A
Vice Consul >
(S ature of Notary Publ,r- State of Flori ' ' ' (Signature of Notary Public- St, nda I
� F100.10A IlAl IASNI
Commission No. j���.Y N(Seal) Commission No. 6-6.38.31 y� e' (SNe? m,;+o r�Gc olAll1
12 1 L J n^' 1 11,k A Ib �{ My Comm. EsOves Je< V. ;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED I
DATE
ev.