HomeMy WebLinkAboutBuilding permit app, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY:
Name:
7�_ Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable
BONDING COMPANY:
Name:
Address:
Not Applicable
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.
5t. Lucie County makes no representation that is grantin a permit will authorize the permit holder to build the subject structure
which conflicts with anj. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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 ail 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 attornev before commencing work or recording your Notice of Commencement.
k 6VL T
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA f , , -
COUNTY OF —
Sworn t (or affirm d) and bscribed before me of Physical Presence or Online Notarization
this day of 20� by
(� LC tr
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
lAII& QJL
(Signature of Notary Public- State of Florida)
Commis �ti
�t Notary Public $late of R.1,0a
Suzette Ritchie
n My Commission GG 135736
a� Expires 12112/2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21