HomeMy WebLinkAboutapplication 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: �
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State.
City:
State:
Zip: Phone
dip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address: ..
City:
city;
Zip: Phone:_
Zip: Phone'
_ _Emmp_
OWNER/ CONTRACTOR AFFIDVITG.
Application is hereby
made to obtain a permit to do the
work and installation as indicated.
certify that no warts or installation has commenced prior to the issuance of a permit.
t. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which i in c(3list with any applicable Hone Owners Association rules, bylaws or and covenants that may restrict or prohibit 5Uch
structure. Please consult with your Home Owners Associatlon 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
on urr n review* room
addltiorr {
accessory structures, swimming pools, fences,
walls,
signs, screen rooms and
accessory uses to another
non-residential use
WARNING TOOWNER: Your failure to Record a Notice of Commencement may result in
improvements to
Lucie County and
with lender or an
paying twice for
in the public records of St.
posted on the jobsite before the first inspection. If you intend to obtain financing, consult
attorney before commencing work or recording your Notice of Commencement.
your property. A Notice of Commencement must be recorded
Signature of O*� LesseejContractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S+ • LLA QA e
Sworn to for affirmed) and subscribed before me of
this � day of 20by
Ex
a
L-.N
Narne of person making statement.
Personally Kn oven P rod used I dent ificatio n
Type of Identification Produced
(Signature of*atary Public- State of Florida )
Commission No. CVC-5 41), (2) (Seal)
- a_1
1 k %I rJ F4 &TA &I
DATE
RECEIVED
DATE
COMPLETED
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
Physical Presence or Online Notarization
Notary public State of Florida
Margaret E Montepare
my Commission GG 214990
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
7�911�i9
F
MANGROVE
REVIEW