HomeMy WebLinkAboutADAMS RANCH_237546_16280499_EP App Pg 2 Signed_11-08-2021SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Jeremy K Wooster
MORTGAGE COMPANY: _ Not Applicable
Name:
AddreSS: 326 Tryon Rd
Address:
City: Raleigh State: NC
City: State:
Zip: 27603 Phone 9196616351
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Address: 4 H Ranch
BONDING COMPANY: _Not Applicable
Name:
Name: PO Box 14920
Address:
City. Fort Plarce
City:
Zip: 34979 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, 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 or an attorneybefore commencin work or recordm our Notice of Commencement.
Signature essee/Contractor as Agent for Owner
STATE OF FLORID n j
COUNTY OF D2af,�.1F
Sworn ty (or affir ed) ano subscribed before me of Physical Presence or Online Notarization
this _ day of 20 U by
GrrG( k"&EO
Name of person making statement.
Personally Known OR Pro ced Identifjcatione
Type of Identification Produced
(Signature of No Iry Public -State of Florida )
Notary Public State of Flonda
Commission No. 441406tig33 (Seal) J Kristee Nelson
My Commission HM 059433
Expires 11x12/2024
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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