HomeMy WebLinkAboutpermitSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: rl� R of L + B L
Address: 22gq & TN AU,!, �S �;
City: VERB E5 >~ A C ii State: FC_
Zip: a 9 fQ I Phone "7`?
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY:
Name:_
Address:
City: —
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable -
State:
'Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count 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 attorney before commencing work or recording your Notice of Commencement.
Signature of Own' J Lessee/Contractor as Agent for Owner Signature o Contractor/License Holder
STATE OF FLORIDA���
COUNTY OF t�
Sworrhh to (or affirmed) and subscribed before me of
, ysical Presence or Online Notarization
this day of I(iC , 2021 by
Name of person making statement.
Personally Known v OR Produced Identification
Type of Identification
P41%red—
na
Notary Public, State of Florida
Commissior t'o mi ion#GG94070)
My comm. expires NOV. 29, 2023
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COUNTER REVIEW
DATE
RECEIVED
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COMPLETED
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STATE OF FLORIDA RqLm
(3��G�
COUNTY OF
Swot/ to (or affirmed) and subscribed before me of
ysical Pre ence Online Notarization
this lP day of 202 by
Name of person making statement.
i
Personally Known OR Produced Identification
Type of Identification
Proodiuced
nat
%'*+,r_Notary
GUADALUPE MARZOA
Commissi Public, State of Ffo(�i# GG 926670
comm. expires NOV. 29, 2023
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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