HomeMy WebLinkAboutDruga app pg 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.
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ln consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the `rork
in accordance with the approved plans, the Florida Building Codes and St. Iucie County Amendments.
The following building permit applications are exempt from undergoing a full concurreney 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 ln paying twice for
improvementstgyou.rprope,rty..AN.gtife,ofcg,mm.ep.ce_ngep±.rTrst£P:_r_eec_e[d_e.d.i_n_t!.e_p_u£P|iE_re:c_o_rd_s_8f_.S}=intend to obtain financing
#.:hei:#:rtyo:::B&Sotrenae;i:¥:rJe°::'iemDee::jrnegt#eo:'krsotr'::g:rc[Ion. IT you lntenu [o oDtain Tinan[ing, consultdingyourNoticeofCommencement.
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SiEnatule6fdyner/\3£sjdd/CbntrdcforasAgentforowner
STATE OF FLORIDA T\ or` c\aCOuNTYOF
:hYs°=±i9L°aryaoirm=d_±nd subscrlbed before me of L£Physical presence or_online Notarization20L2Lby,
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ent.reduced Identification
Type of ldentlflc due \
(Signature of Notary ptiblic-State of Flchda) - -
commissionNOG#l#g#5-7C74(seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGFTATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLFTED
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before the first inspection consult