HomeMy WebLinkAboutBuilding permit app, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
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Address:
City:
Zip: Phone
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IsFEE SIMPLE TITLE HOLDER
Name:
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City*
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Phone:
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State; r-
_ Not Applicable
MORTGAGE COMPANY:
Not Applic
Name:
Address:
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Zi P: Phone:
BONDING COMPANY: Notp�tiC361e
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Name.
Address:
city;
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OWN E R/ CO NTRACTO R AF F1 DVIT: Application is hereby made to obtain a permit to do the work and inxta[iation as indicated.
certify that no work or instaflation 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 granti ng 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 ra n-resident-jal use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result i n paying twice far
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 lenderar an attorney bofore commencing work or recording your Notice of Commencement.
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Signature of Contractor- or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF S�-
Sworn to (or affirmed) and subscribed before me of
th I 15:"' day o€ f �\ 9 x.\-\a+.r , 20 a k by
. . hysical Presence or Online Notarization
Name of person making statement. a cN 6rQ. M elm
Personalty Known OR Produced Identification
Type of identificat�on Produced
(SignatUre of Notary Public- State of Florida) ) , J � 4,�� We -s+to
Commission No. � µ ��O � o� (Seal) � � Amy �
Notary Putiflc
State pf F4ortda
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REVIEWS
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DATE
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DATE
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