HomeMy WebLinkAboutbuilding permitI SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _& Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip Phone:_
Not Applicable
State:
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 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
rnmmpnring work or rerordine your Notice of Commencement.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORJDA
COUNTY OF Cam.
COUNTY OF
The forgoing instrument wqs acknowledged before me
1ykA
The forgoing instrument was acknowledged before me
this_tS dayof by
this is day of 20X1 by
,20�i
Name of aking statement
Name of pers9p making statement
Personally Known 40 OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of FloridaAT )
Commission No. (Seal)
Commis o}�' Natsry Pu�nc aiata ar Florid )
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State of Fl.,ida
My Cornrh wo", GAG 13573e
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ra i Notary publYc
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
ox
R VIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
CO M PLETED
Rev.8/2/17