HomeMy WebLinkAboutbank roof 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: 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 1 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 attorgey, before commencing work or recordi our Notice of Commencement.
>p"t ure of Owner/ Lessee/Contractor as Agent for Owner
gna re of Contractor/License Holder
STATE OF FLORIDA //
CO U NTY O F J]" ( (� C�(�
OUNTOY OFORI' / W
J f _ (/y (it.f
Swor (or affirmed) and subscribed before me of
PhSical Prese a or Online Notarization
this L day f 02%� by
Sworn o (or affirmed) and subscribed before me of
Ph�ical Presen e or Online Notarization
by
Name of person making stattemen .
Personally Known ----OR Produced Identification
Name of person making statem nt.
Personally Known C� OR Produced Identification
Type of Identification
Type of ldentifi tion
Produced 14
Produced
(Signa of No &Expires
(Sig re of -
02 IDA
No. )
a i ComrT�# GCommission
Commission N
c e 9/26/2022
a xpl s 9/26/2
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.