HomeMy WebLinkAboutBuilding Permit App, pg 2 notarizedDocuSign Envelope ID: 24Ao0FB9-BFDO-4E8B-8F01-F341511F87FB
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERf ENGINEER: _ Not Applicable
I MORTGAGE COMPANY. x Not Applicable
Name:'MAR%MA1ASER%nCES,NC {5rzte1
I4 Name. -
Address: ia2a NE JENSEN BEACH BLVD 4686
Address:
State.
City: JENSEN BEACH State: FL
City: _
Zip: 34e57 Phone�+� t12s
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not A licable
pp
BONDING COMPANY: X Not Applicable
_
Name:
I Name:
Address
i Address:
City:
Civj:
Zip: Phone:
Zip: Phone: J
OWNER/ CONTRACTOR AFFI€]VIT: Application is hereby madeto 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. Lurie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
strfjuuu e. PleaF4se with
withpyour Home Owners Owners iandrr Iv ew your d ed or any restri� Ions which maor
apply rbrt such
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 5t Lucie County Amendments.
The following building permit applications are exempt from undergoinga full con currency 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
with lender or an attame before cammenciR work or record" our Notice of Commencement.
LxuslYned by:
Signa see/Contractor as Agentfor Owner
STATE OF FLORIDA
COUNTY OF ST t,ue_xF_
Sworn to (or affirmed) and subscribed before me of
_ physical Presence or Online Notarization
this a _-dav of Dze_ . 2021 by
DAuzn P::C,?C4-
Name of person making statement.
Personally Known OR Produced Identification DL
Type of Identification
Produced 1) L_
REVIEWS
DATE
DATE
Kerry A Sisson
6nmmasam G gW211
Expires 0112212024
FRONT ' ZONING
COUNTER I REVIEW
of Contractor/License
STATE OF FLORIDA
COUNTY OF kA ft--h $1
I
Sworn to (or affirmed) and subscribed before me of
K Physical Presence or Online Notarization
this (f� day of ::r a Rs • 202Qby
12zA et--r win
Name of person making statement.
Personally Known K OR Produced Identification
f Type of Identification
i Sd
(Signature of Nota
a,'sv.� Notary Public State of Florida
? Kerry A
notary nee smiss ❑ r s sarfln GG 950211
p a s am - M y Cornrnr
l Expires 01/2212024
SUPERVISOR REVIIEW ILANI REVIEW I VEGETATION
S REVIEW MANGROVE
VE