HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION
DESIGNER/ENGINEER: Not Applicable rvMORTGAGE~COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and oste on the jobsite before the first inspection. If you intend to obtain financing, consult
w' lender or a ,ttorKOY before commencing work or recording our Notice of Commencement.
Si n tur ss e ne Le / ontractor as ens Agent for Owner Signature of Contractor/Lic er.
TATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF 43' IAt LAAC',' COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓'Physical Presence or Online Notarization Physical Presence or Online Notarization
this__k_day of 2021&by this day of 202� by
Logy.�
ul Gucci._t
Name of person making statement. Name of persoh making state ent.
Personally Known OR Produced Identification ''' Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Z>rl45 t_�CA..r.- Produced v v
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(Signature otaryit (Signature of t P c-State of Florida )
N%WYATTCommission No. =Comml Belli (329928b `\ R01�P'e,, ELLEN)3 Commission :P '; a-NeExplre4Febntary8,2023 lorida-NAa ArublicBandedThruTnyFakMW �N600�157018 Commission # GG 270079,�*r %rF cpq M Co
Oetober2-2 2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION "'' FARTS iChXC GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETED
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