HomeMy WebLinkAboutIMG_0001.pdfSU PPLEM ENTAL CONSTRUCTION LIEN LAW I N FORMATION :
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Lip:.
State:
Phone
MORTGAGE COMPANY: -* Not Applicable
Name:
Address:
City:State:
zip:Phone:
FEE SIMPLE TITLE HOTDER: _ Not Applicable
Namel
Address:
City:
zip:Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
zip:
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, lticie County.makes no representation that-is granting a permit will authorize the per,mit holder to build the subiect structurewnlcn ls ln conTllct wltn any.appllcabie Home Owners Association.rules, bylaws or and covenants that maV restrict or prohibit suchstructure. Please consult With liour Home owners Association and review'yotii deed ioi ahy ieilii;iid;; 'ritiiir,"miv a[ptv"."-'"
ln 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 FAITURE TO RECORD A NOTICE OF GOMMENCEMENT IIIAY RESUTT IN YOUR PAYING
TWICE FOR IMPROYEIIIENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST tNSpECTtOtU. tF yOU TNTEND TO OBTAIN FINANC|NG, GONSULT
WITH IOUR I ENDER OR AN ATTORNEY BEFORE BECORDNG@EIIICEIIIENT."
'/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY Qpstt-ucie
The forqoing instru-'ent was sckneuTlsdge-d before me
this ,( daycc .r-Lau
Name of person making statement.
Personally (6eqi11 xxx OR Produced
Type of ldentlfication
Pr
-24i.
(Signature of Notary Public-
Commission No.
STATE OF FLORIDA
COUNTY Qlstuucre
The forqoing instrumo.+ ,.,as acknowledge_d before me
this -
t i' day of _- -.{-11; .c , 20 t I by
Don Mirsnda
Name of person making statement.
Personally Known xxx OR Produced ldentification
Type of ldentification
Produced
(Signature of Notary Public-
FRONT
COUNTER
RECEIVED