HomeMy WebLinkAbout4310 page 2SUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATloN:
DESIGNEft/ENGINEER: Not Applicable I MORTGA GE COMPANY: Nctt Applicable
Name:Name:
Address:Address:
City: State:City: State:
Zip: Phone Zip: Phone:fl
FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: Not Applicable
Name:Name:
Address: ` c,Address:
Cit.Cit.
Zip: Phone:Zip: Phone:
OWNER/ CONTRACTOR AFF lDVIT: 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.
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ln consjderatfon 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 Builcling Codes and St. Lucje County Amendments.
The followlng building permlt applicat`ons 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 resul t in paving twice for
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c records ctf St.ancing,consult
with lender or an attorney before commencing work or recording voiir Notice of Commencement.''--i
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Signature of Otyfl`d/ Lessee/ContraL€tor as A8'ehtjfor Owner Signature of Contractor/License Hc)lded7 {~J
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Sworn to (or affirmed) and subscribed before me of Swqrn to (or affirmed) and subscribed before m€ of
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Name of person making st.atement.Name of person making statement./
Personally Known +/` ORproduced ldentificatlonPersonallvKnown /' OB produced Identification
Type of Identification Type of lclentification
Produced Produced// -i" i ,, i`.l^
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REVIEWS I FRONT ZONING i SUPERVISOR
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PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE,RECEIVED
'I DATECOMPLETED I
Rev.S|6|2fJ