HomeMy WebLinkAboutBuilding permit app, page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: NOt Applicable MORTGAGE COMPANY: tCNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
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Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: <Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
1 Address:
Address:
city:
City:
if Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to clothe work and installation as indicated.
1 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 anorpev before commencing work or recording your Notice of Commencement.
1 Lure of erppJJAA��see/Contractor as Agent for Owner
STATE OF COUNTYOF— ORJ7"Z_Ai/ i, y
�ysical
Swori),t o affirmed} nd subsumed before Ye of Presence or. Online Notarization
this dayof 20 b
Name of person making statement.
Personally Known OR Produced Identification
Type of Iden ation Produced
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(Sign Lure of Notary Pu Florida)
Beverty J. Prod e
Commission No. NOTARY MAW
STATE OF FLORIDA
CommkOG2132780
EXpif9N Df26/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED