HomeMy WebLinkAboutHandwritten_2021-05-12_212323SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable I MORTGAGE COMPANY:
Name;
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip:Phone:
Name.is
_ Not Applicable
Address:
01,ty: State:
Zip: Phone;
BONDING COMPANY: _Not Applicable
Name:
Address:
city.
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit. '
St. Lucie Count 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 and 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 bodes and St Lucie County Amendments.
The following building permit applications are
exempt from undergoing a full
concurrency review: room
additions,
accessary structures, swimming pools,
fences,
wails,
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 mush be recorded in the public records of St.
Lucie County and posted an the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornkv before commencing work or recordina vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/Li
V,
ense Holder
STATE OF FLORIDA STATE OF FLORIDA 47^/tie
COUNTY OF � � �t i.-4 a _ j COUNTY OF
Sworn to (or affirmed} and subscribed before me of
��Physicai Presence or Online Notarization
this day of MGL2024 by
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Name of person making statement.
Personally Known �"QR Produced Identification
Type of Identification
Produced
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expires: May 4, 202
3onded Thru Aaron Na
SUPERVISOR
REVIEW
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Sworn to (or affirmed) and subscribed before me of
ie-''Physicai Present or Online Notarization
this day of G- I- Afl-L'ey 202� by
Name of person making statement.
Personally Known
Type of Identification
Produced
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(Signature of Notary""
Commission No.
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REVIEW
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