HomeMy WebLinkAboutBuilding permit app, page 2SUPPLEMENTAL CONSTRUCTION LIEN LAM! INFORMATION:
DESIGNER ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State: _
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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.
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 a licable 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 our property. A Notice of Commencement must be recorded in the public records of St.
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Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
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with lender or an attorney betore commencing worK or recording your INIULI t V1 %,V111111C111.C111G11L.
Sig4afdre of Contractor - or WOwner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of � v� � 20Q�YTWL-0
Name of person making statement.
Personally Known OR Produced I e tification
Type of Identification Produced
JA 10
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(Sig ture of Notary Public- State of Florida) Y q C NOTAR LAUUt: Y PUBLIC
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Commission No. (Seal)
� STATE. 0F FLORIDA
C ornn* G G 298272
•s�N. '�� Expires 214I2023
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10/1
SUPERVISOR I PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW