HomeMy WebLinkAboutBuilding permti app, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; _Not Applicable
Naas:
Address,q..
City: state:
Zip: Phone
PEE SIMPLE TITLE HOLDER: _Not Applicable
Name.
Address:
city:
Zip: Phone:
MORTGAGE COMPANY:
_Not Applicable
Norma:
Address;
City: State:
Zip: Phone:.
BONDING COMPANY: _Not Applicable
Naas:
Address.
City:
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 worr, or installation has commenced prior to the issuance of a permit.
t. Lucie Countymakes no representation that his 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, I n 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 undergolng a full concurrency review: room additions{
accessory structures.F swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWN E R: Your failure to Record a Notice of Commencement may result i n paying twice for
Fmprovements to your property, A Notice of Commencement must be retarded 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 attornev before commencinR work or recording vQur Notice of Commencement.
5ig�ture' f Owner] Lessee/Contractor as Agent for owner
STATE OF FLORIDA
COUNTY OF S� ,
Sworn
to
(or affirmed]
and subscribed before
me of
this 1$
day of
202 I
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by
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Name of person making statement.
Personally Known R Produced Identification
Type of Identification Produced
(Signaturejf Notary Pubic- State of Florida )
Commission No. � -\� (Seal)
iysica[ Presence or
Online Nota riz at1 n
Notary Public State of Florida
Margaret E Montepare
ExpiM 06/0512022
REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA
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COUNTER
REIEW
REVIEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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