HomeMy WebLinkAboutBUILDING PERMIT APPLICATION page 2SUPPLEMENTAL E6N! TRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: s Not Applicable
MORTGAGE COMPANY: _ zNot Applicable
Name:
Name:
Address:
Address:
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City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
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City: _ --
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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 1 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 commencine work or recording vour Notice of Commencement.
Signature of Ownerj'1=' see ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 3'� %J aAE
Sworn to for affir�) rd subscribed before me of _ Physical Presence or Online Notarization
thisQ� ay of J V 2o24 by
Name of perso`mmakinR statement.
Personally Known - OR Produced Identification
Type crWentification Produced
(Slgnatu$ef.Ndtary Public- State of Florida )
i*Y►ii •. JAIME 04112
Commission No. 974t (Sea 'P' Notary Publk . State o1 Florida
';; V Commistlon # GG 224444
'?orr.,. ` My Comm, Expires Jun 13. 2022
Bonded through National Notary RKn.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
SUPERVISOR I PLANS
REVIEW I REVIEW
VEGETATION I SEA TURTLE
REVIEW
REVIEW
MANGROVE
REVIEW