HomeMy WebLinkAboutBUILDING PERMIT PAGE 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.
St. Lucie County makes no representation that is 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, 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
,:
Si Lure of Owner/ Les a/Contractor as Agent for Owner
gSignature of Contractor/Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 19 L„ut,
COUNTY OF Sf. Loat
The forgoing instrument was acknowledged before me
this 7.%Uay of arQ�sd' 20�-1 by
The forgoing instrument was acknowledged before me
this 24"A day of Ausust AlZ0by
Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification X
Personally Known OR Produced identification
Type of Identifica�ion
Produced Fiver nvns L1.r►f--
Type of Identification
Produced welt
r
A
(Si ature of Wotary Public- State *ofi,Dylan Christopher Mille
Commission No,f!iG933�$7-NOTARY PUBLIC
tTATEOFFLORIDI
(Sign ure of Notary Public- State of FI ) Dylan Christopher ii
NOTARY PUBLIC
Commission No. 661332$1- I$TATE OF FLORIC
Comm# GG933282
i Cam* GG933282
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