HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: p
one
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Lip: Phone:
)C Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY; Not Applicable
Name:
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 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult 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 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 paying twice for
improvements to your roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and post d on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an atto ne I before commencing work or recording our Notice of Commencement.
a,
Signature of Owner/ Les /Con ractor as Ag nt for Owner
STATE OF FLORIDA
COUNTY OF S'rr. LLi4 i
Sworn to (or affirm d) and subscribed before me of
this �-day of tv ' t' )C , 202-1 by -
h itn. A_t CJL_ i'1,4 t LC Y
Name of person making statement.
Personally Known 'f / OR Produced Identification
Type f.�dentification Produ d
P \ - I
(Signature of N t ry Public- State of Florida
Commission No.
Ph sical Presenc
e ce or Online Notarization
J. W N Notary Public 5tete of Florida
Crystal E Naylon
My Commission GO U9549
a, Expires 111W/2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
DATE COUNTER REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
SEA TURTLE I MANGROVE
REVIEW REVIEW