HomeMy WebLinkAboutSt. Lucie County Permit pg 2.pdfSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address: _
City: State: _
Zip: Phone
City: _State: _
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
Address:
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.
1 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 ppermit will authorize the permit holder to build the subject structure
which is In conflict with any dppllcable Home Owners Association rules, bylaws or anp covenants that may restrict or prohibit such
structure, Please consult with your Home Owners Association and review your deed c r 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
as Agent for
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this II Y day of 1), l 1 20 ' II by
Name of person
Personally Known XOR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida I
i BPENDA A. DECARA
Commission No. aLiS G' ?% (Seal) y°:` Notary Public - State of Florida
Commission r GG 310775
.,wa. My Comm. Expires Jul 1, 2023
Bu�Geo through National NotaryAam.
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