HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2 SUPPLEMENTAL 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 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 Own r esse tractor as Agent for Owner Signature of actor/Lic a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
SW to(or affirmed)and subscribed before me of Swor (or affirmed)and subscribed before me of
VV Physical Presence or Online Notarization Physical Presence or Online Notarization
this ` day of �vl� 2025'by this G day of ul5 202'by
EDWARD J HERITAGE EDWARD J HERITAGE
Name of person making statement. Name of person making statement.
Personally Known xxxxxx OR Produced Identification Personally Known xxxxxx OR Produced Identification
Type of Identification Type o entification
Pr uce Pr uce
'(Signature o ary. 8t2w6 Florida) (Signature of Notary Public- a off.Evans
TSF
NOTARY PUBLIC NOTARY PUBLIC
Commiss' FLORIDA(Seal) Commission No. STATI�LORIDA
Cor> GG262789 Comm$GG262789
REVIEWONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
NTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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