HomeMy WebLinkAboutBuilding Permit (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/ENGIN EER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x 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 lender or an attornev before commencinL7 work nr rernrdincor vnttr NntirP of rnmmPnrPmPnt
C
y
Signature of Owner/ see/Contractor as Agent for O 6
Signa ure of Contract r
ense Holder
STATE OF FLORID a
STATE OF FLORIDA
COUNTY OF saint Lucie
COUNTY OF SaintLucie
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or
Online Notarizatior�
this 8th day of March_ ---"'by
this 8th day of March
0 b
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x
OR Produced, Identification
Type of Identification
Type of Identification
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Commission No. HH105776 ' �S
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Commission No. HH10577s
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REVIEW
REVIEW
REVI�••
DATE
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RECEIVED
DATE
COMPLETED
ev. 5/6120