HomeMy WebLinkAboutBuilding Permit Application (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 TITLEHOLDER: _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 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 leruiel or a attorney before commencing work or recording tice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Conf'ractor/License Holder
STATE OF FLORIDA ry _ ) STATE OF FLORIDA /
COUNTY OF G-lfU L' COUNTY OF /.t�t►�t
Sworn to(or affirmed)and subscribed before me of Sw r to(or affirmed)and subscribed before me of
4/Physical Presence or Online Notarization s Physical Prese ce or Online Notarization
this day of 6�i szr� 202(� by this d y of �a l'� 202f by
7V
Name of person making tatement. Name of person makinY statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced
ature o Notary ublic-State of Florida) (Sigmt6ture of Notary blic-State of Florida)
'E(3ea Erlk Nem� emocil
ommission No. �aR' 2a1 Enk N
Commission No. - V
« _ dommission#GG101 = ,�__ ICommissfon#GG1 2
Expires:May 4,2021 Expires:MaY 4
,,�„ til Inaed t ru Aaron NotaryMOW thru Aaron yo Ify
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.