HomeMy WebLinkAboutBuilding permit app, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 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 oryR4cirdinl; vour Notice of Commencement.
Owner/ Less/Contractor as Agent for Owner
ctor/k(cense Holder
STATE OF FLORIQA < STATE OF FLORIDA
COUNTY OFF` ,,(, COUNTY OF i.t ems;
S to (or affirme 4 and subscribed before me of Sworn to ) and.subscribed before me of
/ye��nce or Online Notarization a or Online Notarization
this —L— day of Il-I eAAq 202p by this day of 202Q by
Name otpet�ssca�-m�king statement. Na,meerson aking statement.
nally Knowr'f OR Produced Identification C Personally Know OR Produced Identification
Produced
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�• MY OM ISSION # GG 090M MY CO MISSION # GG 0993�
Commis 4, y4,2021(Seal) Commissio r IRES: May 4, 202(Ge a 1)
n,.or rs3•• Sv4od Thru Notary Public Underwriters �''�,;;q Ft, .•• 8 ThN Notary Public Underxrtiters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/ ZU