HomeMy WebLinkAboutapplication 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
State:
City:
State:
City:
Zip: Phone
Zip: — Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
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Zip: _ Phone:
n is hereby made to obtain a permit to do the work and installation as indicated -
OWNER/ CONTRACTOR AFFIQVIT: Applicatio
I certify that no work or installation has commenced priogr to the issuance of a permit.
it St.
co ountnflictsynma es no representation
ep able Homeowner AssaclaTion ruleks, bylaws or and covze the enantslthatemaybrestrict or prohibistructure
such re
structure. Please consult with your Homeowners Association and review your deed for any restrictionsperform the wowhich may rk
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, p
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 attorneybefore commencingwork or recordingour Notice of Commencement.
Signature of Cont ct�-orOwner Builder as applicable
STATE OF FLORIDA�
nj-
COUNTYOF—
Sworn to (or affirm d) and subscribed 2abefore �Ye of
V Physical Presence or Online Notarization
this a day of
Name of person making statement.
Personally Known V/I/ OR Produced identification
Type of identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (seal)
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REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
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DATE
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Expires
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My Commission
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