HomeMy WebLinkAboutPermitAppBackSUPPLEMENTAL CONSTRUCTION LIEN W INFORMATION:
DESIGNER/ENGINEER: Not Applica ble
#a°mReTGAfaE /£MPANY: Not Appl icab|eName: .C>EL ti^rcAaJTY
Address: 2` H -a\trea-fao.Address:- '
City: <rufveTZip:1irfec),Aphone 112. 3+I.S2aieiifLr,,,City: State:
Zip: Phone,
LEaEms:YP,.LEiTATLE HOLDER: NotApp|icab|e Rg#ep'NGA°r4PANY: Not Applicable
Addressi /-'Address: - '
City:City:
Zip: 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.
#uLccutcj::::c:3ngt9gc:t:w:i;i,:a°#jteahpp;a:iu:Fn#gtLfie:5h#:isgiars:t£,gaotafopan€gn:trru#6a#u;yr%°#szjerte!d:gpo;:#e3s{t#crht;8nSua##a#S#;##ubii¥uech
ln consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perfor`m 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
WApmNi#oGv:3e°n¥¥:Ry:oYu°ruprrfoa;I:::y[°ARfico°t[geaoNf°ct:C:°infecn°cT#:nncte#:::FeaYerce:#ej3rna#ne85#cf:ercordsofst.
Lucie County and posted on the j.obsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencin work or recordin Our NO ce of Com cement
{`- ...`.`-! ,+--.i.i ,^-
Signature of owner/ Lessee/Contractor as Agent for owner -`---------------i-f=.--:-------,-f=-i---=jr
€tAUT#yFOFFL°R'DAfl.jutciic~scTONUT£#5[oR\DAMA¢J.,rd
Sworn to (or affirmed) and subscribed before me of
##s::arayia:;:::;nd:ea±dfbed:!#b:eofOnlineNotarizationti¥jgsd:ay|:fresLnEL-„ 2o2„OnlineNotarization
' , , ,(, , . , ,LreoNft4.a rfe-oo BA+Lfecde+
Name of person making statement.Name of person making statement.
personally Known ri oR produced Identification Personally Known oR produced Identification JL
Type of Identification
:¥::u°cfe'dden#f4C/a£°#3$4?ol2~Z>Pced
.0
(Signature of Notary Public-StatcommissionNaaqqt>| €r#¥a,ii;¥sii,!£jgn;:e8of9:-r,6¥,FnureofN®P:afrfei;e°grvTri#g9®omssionNo.
REVIEWS FRONT SUPERVISOR PLANS
.fu-. eut"ng e-
ZONING VEGETATloN SEA TU RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED