HomeMy WebLinkAboutPage 2 of permit appSUPPLEMENTAL 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
of Ow essee/Contras or as Agent caner
eSTAE
natu a of Contract License Holder
F FLORIDA,-
STATE OF FLORIDA
COUNTY OF J� ���
COUNTY OF 52CYliry-I e-
The forgoing instr ment was acknowledged before me
this day of r'i 20 � by
The for oing instrument was acknowledged before me
this m ay of ADvil 20z1 by
ShA� br0
_V%v ci*w S�ay\hyD
Name of person making!statement.
Name of person r6king statement.
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
NU4A
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(Signature of o ry u6)c- State of Florida }
(Signature of No ary Public- State Florida )
G61 "I' CHRI�g� MOYNIHAN
Commission No. .�T % �I)
Public
tAUA1EJ09RAC?LEY
Commission No. �% (Sfi)nisslonGGi25876
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State of orida-Notary
- Commission # GG 125775
RAO Fes
N� ExpiresJuiy19,2021
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July
4, 2021
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