HomeMy WebLinkAboutsignature page 2 county permitSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip; Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 is in contact with any appllcable Home Owners Association rules, bylaws or anq covenants that may restrict or prohibit such
structure. Please consult wlth your Home Owners Association and review your deed c r 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
,.,1.11. I,,. A- . ................e„ K f~a rnrnrnonrino wnrk nr rpcnrdiniz your Notice of Commencement.
Signature
STATE OF FLORIDA
COUNTY OF :5 L c c
as Agent
Sworn to (or affirmed) and subscribed before me of Physical Presence or _Online Notarization
this 14 day of J e 4 20_I by
Name of person aking s ement.
Personally Known X_ OR Produced Identification
Type of Identification Produced
—
(Signature of Notary Public- State of Florida )
ti:*riy¢.., aPENDA A. DECARA
Commission No. 6t4, !0? 7i (Seal) 41 *'- Notary Public • State of Florida
� Commission M GG 310775
"or ray Comm. Expires Jul 1, 20n
aonoee throu4h national Notary Assn.
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