HomeMy WebLinkAboutpage 2 of 2SUPPLEMENTALC oN STRUCTION LIEN LAW INF ORMATioN:v ``
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Address: ^
Cit`,/: A State:cit`,,: / \ State:
zip: `lp\01e ,j`\\zip: phone: I 1 / I.:.i(/`\
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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.
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ln 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.
Th`e fo!!o`v^viing bi;i!dir`g permit app!:c€tior.s are exempt from iJndergcing a fH!! concHrrenc`y' re`vJie`v.v.: room 3dc!itior,s,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING T0 OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
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Signature of Contractor -or -Owner Builder as applicable
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=Ph\5ical presence or Online Notarization
Name of person making statement.
Personally Known
Type of Identification Pr
Of -Produced Identification
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED '1 II
DATECOMPLETED
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