HomeMy WebLinkAbout2nd pageSUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: i
Address:
City:
Zip: Phone-:772_
City: State:
Zip: Phone:
FEE SIMPLE TITLE BOLDER:
Name:
Address:
City:
lot Applicable
BONDING COMPANY: of Applicable
Name:
Address:
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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 le der or an attorne F before co mencingywork or recording our Notice of Commencement.
Signature ofOwner/ Lessee ontractor as Agent for Owner
STATE OF FLORI �A�,
COUNTY OF AA i i !
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 20 Z by
P.
Name of person making stAtement.
Personally Known \7 OR Produced Identification
Type of Identification Produced
LL'�E , '0 W'C� P " "q��
(Signature of Notary Public- State of Florida)
Notary Public State of Ftaide
Commission No. (Seal)
Erica Nicole Gray
;� q My CommissionGG961670
Expires OVW20sa „
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SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
PERMIT # ISSUE DATE
COUNTY�
F o 't0A
R.A. Reymann Inc
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company Name/Individual Name)
the Roofing
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for Driftwood Homes
(Primary Contractor)
For the project located at 357 Nettles Blvd Jensen Beach FL
(Project Street Address or Property Tax ID #)
have agreed to be
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,"the, Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONT C GNATURE (Qualifier)
Allan B Morris
PRINT NAME
32 1
COUNTY CERTIFICATION NUMBER
State of Florida, County of ; A
The foregoing instrument was signed before me this V_t� day of
00, , 20_JL, by 4l Un U_fj( i
who is personally known �( or has produced a
as identification.
STAMP
Signature of Notary Public
F0CCA i��Cole �W
Print Name of Notary Public
RiEi
State W FkxitJflGrayn GG 961670
024
Revised 11/16/2016
SUB -CO TR A CIbR SIGNA E (Qualifier)
Ronnie Aarron Reymann
PRINT NAME
CCC1330169
COUNTY CERTIFICATION NUMBER
State of Florida, County of A y,
The foregoing instrument was signed before me this' ) day of
120 by 4 n lei Le— 1 m t' � 4 n Jr)
who is personally known or has produced a (� n i I j/V4e—,
as identifiediion.4
/L/ — — — STAMP
Signat a of of ry Public
Print Name of NCOM1?)?x
• WiAY�, • .•�:
,��//� 4OFFLG4��o\\\\\
PERMIT # ISSUE DATE
OUNT
IF L 0 R 1 D A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
`C1C • ,/have agreed to be
(C any Na e/Individual Name) � N t
the um % n Sub -contractor for
(Type of Trade) J (Pri Dry Contractor)
For the protect located at
DTI %. e�A\es 1 s\an
(Project Street Address or Property Tax ID #)
�AomeS
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
__ gt:;�Izd
CQNTRAC R S NATURE (Qualifier)
�wgxys
PRINT ME
-Z&01
COUNTY CERTIFICATION NUMBER
State of Florida, County of M (i a �i .n
The foregoing instrument was signed before me this _'� day of
Oc— \ U �zt J 20tit bbyy A`GY\ MOiliS
who is personally known V or has produced a
as identification.
b= STAMP
Signature of Notary Public
Ericc, Ucc) �z �/rC4
Print Name of Notary Public
�.' Notary Public Slate of Florida
Erica Nicole Gray
c My Commission GG 9616T0
a a Expires 02/24/2024
Revised 11 /16/201
%j p.SoN
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of ':�tiJ i -Q
The foregoing instrument was signed before me this 1 day of
7
,-A,
who is personally known y or has produced a
as
Signature of
STAMP
,;�rpv'aL•.. CHAD WINTERCORN
Notary Public - State of Florida
Commission # HH 065920
N My Comm. Expires Mar 18, 2025
Bonded through National Notary Assn.
PERMIT # ISSUE DATE
CaO
r r
F<LRID
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance .Division
BUILDING PERMiT
SUB -CONTRACTOR AGREEMENT
Bellwether Electric Company have agreed to be
(Company Name/individual Name)
the Electrical Sub -contractor for Driftwood Homes
(Type of Trade)
(Primary Contractor)
For the project located at _ 357 Nettles Island
(proJect Street Address or Property Tar ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of Change of Sub -contractor notice.
44—,—
C'O'S"I'R.1C 'OR Slf;a`.1't'URI; ((ltuditicr)
S ON'rR;iCTOK SyI�.�N/A,rT�UKE (Quafifierj
p
PRINT NAME
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of4 Id I �'l j_\_
The foregoing instrument teas signed before me this _S_ day of
G�� �, zoo,,) bt _ [� —� n lyl o IFr i 3
with is personally known V or has produced a
as identification.
STAMP
Signature of Notary Public 4A r
Da" Mt'WL'_( C—) ( cky
Print Name of Notary Public
26164
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this 15 day of
September )021 by Charles Hoppmann
who is per tall , kno t or has produ i
as We licati t.
STAMP
Sidairrure of Notary Public
Print Name of Notary Public
6..
Notary Public Sa oa or Florida REE
tate of Florida
Erica Nicole Gray n iroMy Commission GG 1181870 2 GG 23 355732
RevisLd 1111612016 aj ExpiresOZ24/2024
PERMIT # ISSUE DATE
COUNTY
�LoRID.
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
CADC I OF 0:)�:T LU Q y�, N C have agreed to be
(Company Name/Individual Name)
the J Sub -contractor for �RIC4LA (C�A) Wr)m kq
(Type of Trade) (Primary Contractor)
For the project located at
Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie Countypill be advised pursuant to the
filing of a Change of Sub -contractor notice.
COUNTY CERTIFICATION NUMBER
State of Florida, County of V\U(V^
The foregoing instrument was signed before me this <— day of
ot k1.Uf , 20JA_,/by �� A L' S
who is personally known N or has produced a
as identification.
Signature of Notary Public U
g Y
r
(Y C'C, �mc.c kc'. (')(±d
Print Name of Notary Public
SUB -CONTRACTOR SIGNATURE (Qualifier)
111 4 W16►`F_\61 y
s 0
COUNTY CERTIFICATION NUMBER
State of Florida, County of-5T Luck,
The foregoing instrument was signed before me this
13
_day of
' 202 , by Ni%LkW A 1`"IZ&ye k
who is personally knownxor has produced a
as identification. /J
STAMP _
Signature of Notary ublic
Print Name of Notary Public
Notary Public Spine Of Florida
Erica Nicole Gray
Revised 11/16/2016 ` MY Commission GG oel67P0
a w Expires 02t242024
Notary PUN C stilt d Florida
David can Dwm
Attl"W CW W GG 2WW
q Expirea�fltT/Zp23
3`Y�57
STAMP