HomeMy WebLinkAboutMadonia app pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :
DESIGNER/ENGINEER: Not Applica ble MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Address:
• City: State:City : State ,
Zip : Phon.e Zip: Phone:
i.EE SIMPLE TITIE 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.
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ln consideration of the granting of thls requested permit, I do heredy agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucle County Amendments.
The followlng bulldlng permlt appllcations are exempt from undergoing a full concurrency review: room addltions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another nan-residential use
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with lender or an attorn before commencin work or recordin our Notice of Commencement.
r as Agent for Owner
STATE OF FroRIDA
cOuNTY OF t\tue;T` J
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REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TU RTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED