HomeMy WebLinkAboutScan_0017SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
ESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
State
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: XNot 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.
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 attornev before comrnencinl~ work or recording; vour Notice of Commencement.
U �_ 6"�
t J�' Ct � 62'1_L-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sig ure of Contractor/License Holder
STATE OF FLORIDA
CA
STATE OF FLORIDA
COUNTY OF_
COUNTY OF F
Sworn (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
h sical Prese a or, Online Notarization
this ` day of 2020 by
"P sical Pres a or Online Notarization
this day of 2020 by
'
Name of person making statement.
Name of person making statement.
Personally Known � OR Produced Identification
Personally Known L. _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State of Flori )
(5ignat r f� I a'
Com Skate of Ft°ridgy (S I)
7 r� Notary public State of Florida
Com Suzette RiEchie ( al)
i,�.
•u�, Now I
`JF suzemr6lssioj GG 13hie573s
N,o
MY om � 135736
Exptres 1211212021
a.
�xPiras 12
REVI �`�
NING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20