HomeMy WebLinkAboutApplication 2105-0283SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:Name:
Address:Address:
City: State:City: State :
Zip: PhoneFEESIMPLETITLEHOLDER: Not Applicable Zip: Phone,
--BbNDING COMPANY: Not Applicable --I-~--
Name:ufynnoouadingco,p Name:
•Addre5s:i".swi22Ave .`,Address:City:-City,
Zi p: 331es P hone ; asi378ca27,Zip: Phone:
O`M\lER/ 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 tias commenced prior to the issuance of a permit.
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ln consideration of the granting of t+his requested permit,1 do hereby agree that 1 wiii, in ail respects, perform the work
in accordance with the approved plans, the Florl.da Buildi.ng Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additjons,
accessory structures, swimming poo's, fences, walls, signs, sc,reen rooms and accessory uses to another non-residential use
WARNII\lG TO OWNER: your faiinre to Record a ce of Commeticement may resLIlt ill paying twice for
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Name of p.erson maklng statement.Name+ctf person making statement.
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PersonallyKnown-ioRproducedldentificationPersonallyKnown I,'''. OR produced ldentificatic>n_
Type of ldentific ation Type of Identification
Produced.,,.,.-Produced
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RIVIEWS
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MANGRCIVE
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SEATURTLE
COUNTER REVIEW REVIE REV REVIEW REVIEW REVIEW
DATERECEIVED I )
DATECOMPLETED
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