HomeMy WebLinkAboutBuildingPermitApplication pg2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 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, 1 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 n the jobsite before the first inspection. if or
intend to obtain financing, consult
with lende an att before commencingwork or recordin our Notice gf AS7nmencement.
Sig ture of Owner/ Lessee/Contractor as Agent for Owner
Si nature of Contra or/License Holder
STATE OF FLORID
L,��e—
STATE OF FLORID
COUNTY OF (•
COUNTY OF
Sw to (or affirmed) and subscribed before me of
Swpeflto (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
P sical Pre ence or Online Notariz
thisday of A `
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Pro-duced
Produce
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(Sig ure No
;:{p}vpue;, ELIZABET' M RAN
(Signatu of Not y
ELIZABETHMORAN
"� oe`'•
i°> > ��, Notary Public • State of Florida
Com fission O. �= ^ mission k%U �t8346
No • �n? Notary Pubf a of Florida
Commissio
My Comm. Expires Mar 6, 202a
Commiss 948346
''�oaF My Comm. Expires Mar 6, 2024
Bonded through Nationai Notary Assn.
Bond A
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
MANGROVE
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20