HomeMy WebLinkAboutBuildng permit app, pg 2SUPPLEMENTAL CONSTRUCTION LIENIAWINFORMATION,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:
Name:
Address:
City* State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address-,.
City:
Zip: Phone:
Not Armlicable
Name: �
Ad d rt
City: State:
Zip* Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City;
Zip: Phone:
OWNERS 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 +Court + makes o representation that i granting ermit will authorizethe permit holder t
whichi� conflict ian��� ��ii� the ����c�t structure
applicable Horne Owners Assocso atior rules, bylaws or and covenants that � restrict r prohibit
Ownersstructure. Please consult with your Home Association and review your deed for any restrictions which ay apply.
n consideration f the granting of this requested permit, M do hereby r e that I wi
ll, '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 fro undergoing additions,
accessory structures,, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential
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 or an attorney before commenciork or recording your Notice of Commencement.
Signature
er/ Lessee/Contractor as Agent for Owner
STATE OF FL'`0
RIDA
COUNTY OF
Sworn to
(or affirms
d subscribed
before
me of
this�
day of
A*�Pr
204U
by
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Name of person making 5ta�ement.
Personally Known V OR Produced Identification
Type of identification Produced
(signature of Not y Publie- State of Florida )
Commission No. (Seal)
Physical Presence or
Online Notarization
Notary Public Stara of Florida
Margaret E Montepare
Expires 06105/2022
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