HomeMy WebLinkAboutDocument_2021-06-07_130041.pdfSUPPLEMENTAL 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.
I certify that no work or installation has commenced prior to the issuance of a permit_
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which isin conflict with anyapplicable 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 property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and pasted on the jobsite 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 of Owner/ L4ssee/contractor as Agent for Owner Signature of ContraU. /License Holder �
STATE OF FLORIDA� - � . ' � STATE OF FLORIDA
COUNTY OF � � C.- COUNTY OF
Swol to (or affirmed) and subscribed before me of Swo�p to (or affirmed) and subscribed before me of
Ph sical Presen e or Online Notarization ��hysical Prese e or Online Notarization
this day of v`L��202d by this day of � �l V1�. , 2024 by
4-- X0 - W111)
Lit/ KOO
Name of person making statement. Name of person making statement.
Personally Known � OR Produced Identification Personally Known ' OR Produced Identification
Type of Identification Type of Identification
Produced �%� ProducedAl
WW
(Signature of Niorary Public- Si ` "da jEng2 �ignature of Notary Public- State of FJo�'� i
Comm #HH10583 ���: '� EA Nemo
Commission No. �ez&pires:May 4,202 Commission No. Spa Comm #HH I ;
o� ' B�pnded Thru A-BM—n N ry .a �P►►+95: May 4
AR
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 576/20
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2.5
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