HomeMy WebLinkAboutBUILDING PERMIT APP (2)SUPPLEMENTAL 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 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 attorney before commencing work or recording our Notice of Commencement.
10 X�11J. 'L (� - 4 M -
A,&
i nature Owner/ Lessee ntractor as Agent for Owner
/ g
Signature of Contractor/License Holder
ATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFSt. Lucie county
COUNTY OFBroward
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 Notarization
this 26 day of APRIL 2020 by
this 26 day of APRIL 2020 b
f Y
Jennifer D Ray
Greta B. Smith
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Driver's License
Produced
// 4' (, L L a- 41
(,&LcLei
(Signature of Notary Public State�gf FAQ jda
(Signature of Notary_Public. a cif Florida)
o� aY PUA` SHAFd.I, I V'=LIAN
Commission No. i3 ' °_ r�Ot�fi;ll5,�r� a�JGG916TL6
afP
SHAf'LItJ �irLI�,N
Commission No : yk Mycol,1r, 1a{ ?.:�� G996726 I
EXPIRES: Se- tr:,nl)er 26, 2023 !,.
a
r� o, S 15
� �;: EX. RcS: a,.N,e�nber r,, 2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION`
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5