HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SUPPLEMENTAL CONSTRUCTION LIEN -LAW INFORMATIONN
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address',
City:
---
Zip: Phone:
MORTGAGE COMPANY.
_Not Applicable
Name:
• • _ • PPP■�I�P_ - !7_■1'P■�
Address:
fY ii�l .. _ I ■ . ■ ■ I ■ PPI .
City: state*
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
�I .. .. _PPP■•�7■+7 __
Address:
City:.
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OWNER/CONTRACTOR AFFIDVIT: Application is here � � ■
obtain permit work instal --'
late n as indicated.
i certify that no work or installation has commenced Prior to the Issuance of a permit,
t. Lucie Count ■makes no representation that is grantingpermit will authorize the permit holder to bu*f1d the subject structure
which is i coy i i t with a applicable o Owner Association rules I F
i � � �� and covenants �#��� ��r�t or prohtbrt such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.,
n consideration of the granting of thisrequested permit, I do hereby agree that i will in all respects, erf rr 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,o 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.
Lurie County and posted on the Jobsite before the first inspection, If you intend to obtain financIP
ing, consult
with lender or an attorney before commencing work or recording your Notice of commencement.
Signature of
t
W
ner/ Lessee/Cflrttraktor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me o
this 4 day of % _ Lali 4, 20
A E-:�" n
Name of person making statement'.
Personally Knower OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Cc mi5.ild11 FVD• r + 17f�1 ���{�.�� (Seal)
REVIEWS
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FRONT
COUNTER
„� Physical Presence or
.�.,�. Online Notarization
NOWN PUblis State of Florida
Margaret E Monte pa r
My Commission GG 214990
04� )
Expires 0610512022
OF
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