HomeMy WebLinkAboutBuilding Permit App - Eden Rd (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :
DESIGN ER/ENGI NEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: XOjr, n o4 on 0 avS' Name :
Address : 7�lv1 Q ^ r- Address :
city: � � •�- o state : city: state :
Zip : Phone - 4 (7 1 735 Zip : Phone :
FEE SAMPLE TITLE HOLDER: Not Applicable BANDING COMPANY: Not Applicable
Name : Name:
Address : Add ress :
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.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is %anting a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners ssocfation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please cansu�t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I coo hereby agree that ! will, in all respects, per-form the work
in accordance with the approved Mans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to anther non -residential use
WARNING TO SINNER: Your failure to Record a Notice of Commencement may result in paying #wise 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 Tender or an attorney before commencing work or recording.your Notice of Commencement.
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLOR A - l
COUNTY OF ST , \e--
sworn to for affirmed} and subscribed before me of Physical Presence or Online Notarization
this day of 20ik2- by
a, V, 0 \ �k *� NMIN ' k C-) \0 R. C, "�V !S
Name of person making statement,
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary a date of Fl� GIVENS
r�-���'- ►�a[:r!r Public • State of Fianda
CDmr�iS5io11 N0. � � - gtiss►an � 4i� 0�535�
`: fires Aar, �S . 2425
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Acnded through National Notary Assn-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SSA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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