HomeMy WebLinkAboutapplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT'ION..
DESIGNER/ENGINEER: _Not Applicable
Name:
Address..•
City: State:
Zip-* Phone,--
FEE SIMPLE TIT HOLDER: _Not Applicable
Name:
Address,•
City:
Zip: Phone:
MORTGAGE COMPANY:
_ Not Applicable
name:-
Address.
City: State:
Zip: Phone:
BONDING COMPANY:
,,,,.Not Applicable
Name-.
Addressi.
city�
Z. * Phone:
OWNER/ CONTRACTOR AFFIDVIT,&G 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�r makes no representation that is granting a permit will authorize theermit pholder to build the subject structure
which i s i n con"flfct 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., 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 must be recorded in the public records of St.
Lucie County and posted on the J'Obsite before the first inspection. If you intend to obtain financing,consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature at Owner/ Lessee/Contractbr as Agent for Owner
STATE OF FLORIDA'
COUNTY OF L.
Swor o (or affirmed) and subscribed before me of
Ph-Mcal Prese r Online Nnzation
this day of 20Tby
Name vf perrvbn making statement.
Personally Known OR Produced Identification
Type of identification
(Signature of Notary Public. State at Florida )
Commission No..
REVIEWS
GATE
REC.EIVED
DATE
COMPLETED
ev. 5/6/zu
(Seal)
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Signature of Contra ctor/ License Hodder
STATE OF FLORIDA
COUNTY OF
Swor -to (or affirrned) and subscribed before me of
Physical�Pr en
this , dad of
Online Notarization
210Z) by
Name of persoWmakine. statement.
Personalty Known � OR produced Identification
Type of identification
Produced
(Signature of Notary Public- St
Commission No.
PLANS
REVIEW
VEGETATION
REVIEW
r. SHELLI LESTER R
Ilk
�w gp f Florida -Notary u lic
dr liIMission k GG 19 6
My Commission Expi e
MarCh--1-1- SEA TURTLE MANGROVE
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