HomeMy WebLinkAboutScan 1.pdfSUPIP LEMENTAIL CONSTRUCTION LIEN LAW INFORMATI0N:
DI=SIO N ER/FNG I NEER: _ Not Apli-icable
Narne.-
Address; -
City: State'
Zip: Phone
FEE SIMPLE 1 ITLE H OLD ER: _ Nert Appiicable
MORTCPAGE COMPANY: � Not Applicable
Name;
Address;
Clty: State:
Zip; phone,
BONDING COMPANY: Not Applicable
Name;
Name;
Address;
Address;
City.
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Ottir:
Zip: Phone,
ZI-P; Phone;
OWNER/ C40NTRACTCMR AFFIDVIT: Application k5 hereby maide tp obtain a permit to da the work a nd instal IatiOrr as indicated,
I Certify that no work or installation has mmmence•d prior to the issuance of a permit,
5t Lucie County makes no represerftatian that is granting a permit will autherize 2aroolnarLU
rz hcl&r to build that Subject SteLLMre
which Is in conflict with any �pplrcaWe Home Owners Assoraartion rules, bylaws �#hat may. restrict or prohibit such
Stnuttur8, Please coinsult wit your Home Owners Assaoa ion and review yrour ar y restCvlons wN h mav 2 pph+.
kn cpnsidera ion Of the granting of this requesleLd -permlt, I do herebV agree that I w+14 in all respe€t�, perform the work
In accordance with the apiprooed plans, the Florida Building Odes a-nd St Lucie County Amenclmenu.
The following building permit applications are exempt from undergoing a full oancurrency review. ro m addWons,
accessory struour swlmml" two1r, fens% walls, signs, screen rogm and accessory u54�s to anDther non-residential use
WARNING TO OWNER: Your failti re to Revved a Noticj� of Cornrneincement maryr re,su It Kn prayl rig twir& for
I rn provements to you r p rupert . A N otice Of Conn mencem ent rn ust be recorde d I rt th e p ub I iC record$ of St -
Lucie Cou ntyr and p ted on the jobSite before the fiat I nspect ion. If you i me rid to obtai n fi na ncing, co risu It
r with lender or an att om eY before core- menctng work or record i rig -rou r N otice of_Comme rice merit. �
SlWmture of Owner/ LessevJContraetor as Agent for Owner ,
STATE QF FLORIDA
COUNTY OF
4-omrn to (ct afflrmea) and subscribed byre me of
_ Phwskal Prlasenue or Online Notarization
this dray of . Z0210 W
Name ct ps rson making statemergt-
Personaklw Known OR Prod coed rdentikabon
Type Qf I dentincation
Produccel
{$Ignature of Notary Publ ir- State of Fborida j
Corn miss+om No.
(Seal]
of
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed] and Subsd'ibed b0ore m-A of
Ph is! Presence or Online NotaFlxatlon
this day of204 by
Name of person making statement.
Known OFt PriWuced
(5ign,bturlt of Notwy Public- StMe of Florida J
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Rev, 51612ca