HomeMy WebLinkAboutScan_0029SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
Zip: Phone:
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
urith Ianrlar nr an attnrnPv hpfnrp enmmQnring work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA { A h
COUNTY OF
COUNTYOF
Sworn (or affirmed) and subscribed before me of
Sworn to(.or affirmed) and subscribed before me of
h sical Presen a or Online Notarization
this day of 4WO by 'oO-M
yslcal Prese ce or Online Notarization
thisof by D&D-j
�}_day
Name of person making statement.
Name of person making statement.
Personally Known L"/ OR Produced Identification
Personally Know OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o )
(Signature of Notary Public- State of Florida }
Commission .stowOt ow'. (Se }
Com No. (Seal)
r g�ettc1 r.G 1,357205yppr
msss
P
No
REVIE $ea:�
6Suzette
�PUNTCR
ZONING
SUPERVISOR
P 5roi
Ritch'
c G °IpObkion
of Florida
§ TURT
MANGROVE
REVIEW
REVIEW
REz2/72/20
RW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.