HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE # 2SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commen " 2 work or recordin2 vour Notice of Commencement.
;�Allx djv\'-�
C-NO�
Signs re f wner ee/Contractor as Agent for Owner
Signature of o actor/License Holder
STA E OF FLORIDA Hallman, Susan
STATE OF FL�rRIDA
COUNTY OF
COUNTY OF '
The forgoing instrument was acknowledged before me
July
The forgoing instrument was a knowledged before me
this D3 day of S 20 at by
this ay of 2o2l by
Hallman, Susan
,r ine--5 Q ,_V ,,s
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced Driver's Licence
Produced
31 lavG' 'to ok-M-
(Signature of Notary Public- State of Florida)
(Signatule of Notary Publ' - State of Florida )
MARYLEEMATTIS
Commission No.l ) O.AYVuB�
C� t{q ? QSeadommission#HH08949
Commission
Expires March 6, 2025
P
o� ExpiresAp 112,2C '4
rF OP ded Thru Budget Notary Sei
p� p. Bonry
s y .,;
t`Ur. Bonded rhru Budget Notary Services
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17