HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
V Not Applicable
State:
MORTGAGE COMPANY•.
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
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. applicable 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 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 attornev before commencing work or recording your Notice of Commencement.
QA,�-� - ,A, --)
Signature of Contractor - r - Owner Builder as applicable
STATE OF FLORIDA--,-
COUNTY OF
Sworn to (or affirmed) and subscribed before me of 'L.-I Physical Presence or Online Notarization
this ` + day of 75jinvv, 20 2by
Blame of person making statement.
Personally Known OR Produced Identification
Type of 1 ratification Produced r-1, l� f
(Si nature of ry Public- State of Florida)
Commission No. (Seal)
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ro Notary Public State of Florid
"��_ Commission # HH 550
of My Comm. Expires Aug 25, 2024
Banded through National Notary Assn.
REVIEWS
FRONT
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SUPERVISOR
PLANS
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SEA TURTLE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Itev 10/12721