HomeMy WebLinkAboutCHRISTIANSEN RD 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: � Not Applicable
Name:
Address.
City * State,
Zip: Phone
FEE SIMPLE TITLE HOLDER: � Not Applicable
Name.
Address:
City:
Zip: Phone:
�r
MORTGAGE COMPANY:
Namel
Addresst
City:
Zip:
Phone:
BONDING COMPANY:
Name;
Address:
city:
Zip: Phone.
Not Applicable
State:
Not Applicable
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as in
I certify that no work or installation has commenced prior to the issuance of a permit.
t.. Lucie ou nt rya es no representation that is grantinga permit will authorize the permit holder to build the subject structure
which i in con list with any applicable �-- om Owners Association rules h la ors or an covenants that may restrict or ro ihit such
structure. Please consult with our Hone Owners Association �
a � �� r��r�r your died for are restrictions hi apply.
In consideration of the granting of thisthi's requested permit, I do hereby are that l will, In all respects, perform the work
i n 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 con urr n review: room additions,
accessory structures, swimming pools, fences, wails, signs., screen morns and accessory uses to another non-residential use
WARNING TO OWNER: YO111" failure to Record a Notice of Corremenr.pmpnt may rpc»It in navint%uiro fnr
improvements to
Lucie County and
with lender-o.r an
.. ...' v.rw..... r. r.'0 ►ii era. V
your property. A Notice of Commencement must be recorded in the public records of St,
posted on the jobsite before the first inspection. If you intend to obtain financing, consult
attorney before cammencing work or recording your Notice of Commencement.
Signature of Owip','-r/y.,essee/Contractor as Agent for owner
STATE OF FLORIDA4
COUNTY OF 4,:Sj. LL�cj f,..b
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this IS day of 0C'�'DbC 20�,1 by
-T tA k.- P�
Name of person making stat ment.
Personally Known DR Produced Identification
Type of Identification Produced
i
(Signature'of-NAary Public- State of Florida �
Commission No. ����q�i� (sear
V P
MW
Notary Pub is State of Florida
Margaret E Montepare
My Commission GG 214990
Expires 01510