HomeMy WebLinkAboutPERMIT APP , PAGE 2SUR CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER: _
Name: utC F,o 2 r_E+
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Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: i195f7fD tl t
Address:
City:
Zip: -1058 Phone ?72-
State: L
5SR ., b7241
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
of Applicable
BONDING COMPANY:
Name:
_Not Applicable
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.
St. Lucie County makes no representation that is Vntin, a permit will authorize the permit holder to build the subject structure
which conflicts with any 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 lender ar an aftornev before commencing work or recording your Notice of Commencement.
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Signature of Owner/ Lesse Contractors Agent for Owner
STATE OF FLORIDA
COUNTY OFs..A.• fzo , i
Sworn to (or affirmed) and subscribed before me of !-Physical Presence or Online
Notarization
this Wi tlayof 0_4rUtr 20Zi by
Name of person making statement.
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Personally Known OR Produced Identification
Type of Identification Produced
DAMD N, OINN
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(Signature of Notary Public- Stateof Florida)
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REVIEWS
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SUPERVISOR
PLANS VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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