HomeMy WebLinkAboutapplication 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:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zi p: 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.
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 n attorney before commencing work or recording your Notice of Commencement.
Signature of O ner/ Lessee/Contractor as Agent for Owner
Signature of Contrac r/Liceni§e Holder
STATE OF FLORIDAS- -
STATE OF FLORIDA \ �
Lc
COUNTY OF UQ
COUNTY OF 1
Swor (or affirmed) and subscribed before me of
Sw,orn�(or affirmed) and subscribed before me of
Plivsical Presppce pr Online Notarization
this day of 202by
tion
this d°a�y'of 202(� by
Name of person making' statement.
Name of person making statement.
y
Personally KnownOR Produced Identification
Personally Known v OR Produced Identification
Type of Identification
Type of Identification
Produced -'
Produced
Signature of Nota y Pu f:. s'c+$IO1.0m #HH1 5838
' I1 : May 4, 2025
(Signature of Notary Public-Sta2o r �_ Comm #HH1
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Commission No. .—
Aaron
Commission No. -•� .� a§XQ1►6S: Ma 4
Notary
''�,.°,�ma,�� nded Thru Aaron,
REVIEWS
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SUPERVISOR
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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COMPLETED
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