HomeMy WebLinkAboutDziedzic permit application 2of2SUPPLEMENTAL CONSTRUCTION LIEN LAW 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
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an 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, swim in fences, w , signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure t rd a Notice of Commencement may result in paying twice for
improvements to your prope . A Notl f Commencement must be recorded in the public records of St.
Lucie County and posted on t e jobsite befo the first inspection. If you intend to obtain financing, consult
.��th lender or an attorney fore commencing rk or recording your Notice of ComnnPnrPmPnt
Si ture of Contractor - or Owner uilder as applicable
ATE OF FLORIDA
C UNTY OF
Sworn to (or a i subscribed before me of
Physical Presence or Online Notarization
this kq day of 20,?Aby
Name of pe s n making statement.
Personally Known X OR Produced Identification
Type of Identifi tion Produced—
(Sinat6re of tart' Public- State of Florida)
Commission No. (Seal) . .
+i
Notary Pu tate of F}orida
Lynda A Hadley
My Commission GG 284432
as
Expims 12l1612022
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