HomeMy WebLinkAboutapplication 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIONOF.
DESIGNER/ENGINEER:
Not Applicable
Name:
Address:
it : State:
Zip:
Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
4}
Name:
ddr:
Cityl.
.
Zi p: _Phone.
Not Applicable
OWN ER/ CONTRACTOR AFFI DVIT: Application is hereby made to obtain a hermit 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 y makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which IS in C�17flict with any applicable Home Owners Association ruses, b}jIa1NS Q!' �11C� CaVen�lfltS that may restrict DC 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 Br it applications are exempt from undergoing a full concu rrerrc review* room additions,
accessory structures swimming pool , fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER,.o 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 Notice of Commencement.
Signature of Owner/ Lessee/contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF met r in'
Sworn to (or off i rmed) and subscribed before me of
this day of A \)!z 0 b
1 h'J.M61 C'
Name of person making statement.
Personally Ian n OR Produced Identification �
Type of I ifitin �.
(Signature of Notary Public- fdf -of Florida
.tav +�r�4 STEVEN ANDS
Commission ••�+•. fi *G4�1)
• �„ � Expires QecrntbM"I O.3=
OfF`o*� �on�bihru�lN�ryi�M
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
FRONT
COUNTER
ZONING
REVIEW
�h sisal Pr ence o r Online Notarization
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW