HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2 -SUPPLEMENTAL,CONSTRUCTIONe LIEN, LAW INFORMATION'.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: .T�.t� Q A-t G" Name:
Address: &6b� it 9ArL4A a.►n1 (XD Address:
City: -5YV lam— State: r City: State:
Zip:3 qA 7 Phone a6 -3-a6-27 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: j29— r�`L Name:
Address: 5 ocy40 D2, Address:
City: ;3-P*440 Pz-, City:
Zip: 3Y )S7 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 conflicts with any.applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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.
Lu ' n y and post—eZh5.n the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney befXe commencingwork or recording our Notice of Commencement.
Sig tune of Contr ctor-or-Owner Owner eras applicable
STATE O
COUNTY OF f"y1��Zr //Y
Sworn to(or affirm d)and subscribed before me of " Physical Presence or Online Notarization
this day of 1 c LIN d bA 20 Ll by
i�d CC-/-L 7 �-Ah 4Ar
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced 0-17 i V rg <r Lr e rA,cc
(Signature of Notary Public-State of Florida
Commission No. /��/�o�S yf No=Rice
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10/12721