HomeMy WebLinkAboutDocument_2021-05-25_112230SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name... Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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.
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.
Inconsideration 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,
accessary 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 properly. A Notice of Commencement must be recorded in the public records of St.
Lucie bounty and pasted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an a��ey before commencing work or recording your Notice_f Commencement,,
Signature of Owner/ LessKe/Contractor as Agent for Owner Signature of Contra ctorjCicense Holder
STATE OF FLORIDA � lu
STATE OF FLORIDA /
COUNTY OF � t�1l�, COUNTY OF 'f Gu
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Sworn to (or affirmed) and subscribed before me of
Phgsical Prese ee or Online Notarization
this day of ��� , 2020 by
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Type of Identification
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