HomeMy WebLinkAboutSallee app pg 2SUPPLEMENTAL 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.
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The following building p.ermit 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 nan-residential use
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Lucie County and posted
with len ttorne before comrhencin work or recordin
op tt!e jobsite before the first inspection. If you intend to obtain financing, consult
our Notice of Commencement.
or as Agent for Owner
or affirmed)and subscn.bed before meof L£Physical presenceor
2qEL by
Online Notarization
Name of person maklng statement.¥#L= _
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REVIEWS
DATE
RECEIVED
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETED