HomeMy WebLinkAboutapplication 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ ssee/Contractor as Agent for Owner Signature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY COUNTYOF Gt�rL��
Swoyn to (or affirmed) and subscribed before me of Swo� to (or affirmed) and subscribed before me of
L_ Physical Presence or Online Notarizationy Physical Presence or Online Notarization
this day of —/' 20 nby ! this ,day of l (f C? 2020 by
Name of person making statement. `-' r'-v //0 I Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Brandon Celhus
Producedl. . ? Notary Publio
State of Florida
kY Ommission Expires 09
(Signature of Notary Public- State of Florida Yc' 'on Na cG 6
Commission No. L, (Seal)
Personally Known OR Produced Identification
Type of Identification Brandon Cetlun
Produced Notary Public
State of Florida
/2023 My Commission Expires a
"ignature of Notary Pu`61ic- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20