HomeMy WebLinkAboutBuilding Permit App (2) 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 TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: 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 e recorded in the pugl�r r s of St.
Lucie County and posted on the jok&zft eforc the first inspection!I you intend to obt 'n f�nar�Fm ,e nsult
with lender an ttorne b e e�mtn �jcm' work or recordin ou Notice of Co endem'Rt,
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Signature er/ ss ' Con ractor as Ag`'rit'fgr��Wne Signat e actor 'tcense Holder STATE OF FLO N STATE F FL ACOUNTY OF l l "� COUNTY OF
Swor or affirmed and subscribed before e' 6_,°yo.v > Sworn
( ) i, (or affirmed)and subscribed befysical Prese c or Online Notar' � o ✓P ysical Pre n e or Online Nday 'Y 2020 b .. oN'
Name of person making statement. ame of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdertUflipation ( Type of Id e ' ication
Prod ced ( V \ Produ ed i(l V
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Commission No. UltA_ (Seal) Commission No. 21 '5 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5