HomeMy WebLinkAboutBuildling permit app, page 2SUPPLEMENTAL 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
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
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.
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSyFD ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF Y4U INTEND TO OBTAIN FINANCING, CONSULT
T OUR LENDE OR AN ATTORNEY BEFORE RECORDING NOTICE F OMMENCEMENT."
V
Signature o wne Lessee/C r as Agent for Owner
Signature clif Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 1\AO v-*n
COUNTY OF Mar4,n
The IKKPing instrument was acknowledged before me
this 4 day of �—, 20jMby
The forgoing instrument was acknowledged before me
this � day of F=e� 20 6Qby
C�he.Jer►he Ellison
Cheyenne 611SOn
Name of p rson making/statement.
Name of person makin/�ystat ement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produce
(Signat o o P blic- S
ignatur otary Pbli - a e o F i
„s+ Notary Public State of Florida
+Q N McIntosh
Commission No. a C miaaon GG 283399
• a Expires 12n 12022
O - Notary Pubic State W Fbrid.
mmission No. Deslrk6e4 cin10Sh
+a My Commiaeion GG 203399
ar ti Expires 12I712022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19