HomeMy WebLinkAboutBUILDING PERMIT PAGE 2SU PPLEM ENTAL CONSTRUCTION LI EN LAW INFORMATION/
DESIGNER/ENGINEER: Y wot Applicable
Name:
Address:
City:State:
zip:Phone
MORTGAGE COMPANY: ft\ot Applicable
Name:
Add ress:
City:_
Zip: _
State:
Phone:
FEE SIMPLE TITLE HOLDER: _[Not Applicable
Name:
Address:
City:
zip:Phone:
BONDING COMPANY: $Not Applicable
Name:
Address:
City:
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 Countv makes no representation that is granting a permit will authorize the permit holder to build the subiect structure
which conflicts with anv applicable HomeownersAssocialioh rules, bvlaws or and coVenants that mav restrict or prbhibit suchstructure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
ln consideration of the granting of this requested permit, I do hereby agree that lwill, 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 your property. A Notice of Commencement must be recorded in the public records of St.
Lucje County and posted on the jobsite before the first inspection. lf you intend to obtain financing, consult
with lender or an attornev before commencing work or recordi Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
[ciu riri' cii- "' -^S { . l--ir-
Sworn to (or affirmed) and subscribed before me of
this 1ffiy ot (bv,p*-tz , zo &4by
121 eny r, r^l P rese nce or Online Notarization
Name of person making statement.
Type of I Produced
of Notary Public- State of Florida)
commission No. l{ fi eO 8g {8 (seat)
JESSICA RICE
I(Y COMMISSION #HH208898
EXPIRES: DEC 1 6, 2025
Bonded through 1 st State lnsuranca
VEGETATION
REVIEW
SEA TURTLE
REVIEW
DATE
COMPLETED