HomeMy WebLinkAboutAPF Permit App Pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: Izac7
City: _P," suVze,-3 State: T—t-,
Zip: 43 Y ;� a Phone , r%�-:i`7 V- 3 1) •3
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: 15,,,J v, o k-Zl 0Cr `) i �-tc-5 5 � L
Address: �E,`7 6L,0 FV24401LF�'5A
City: V)8' --yr 1,0CA`L F�1_
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip:,
Phone:
Not Applicable
State:
Not Applicable
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 any 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, 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
;uith;lEnderoran
operty. A Notice of Commencement must be recorded in the public records of St.
y and posted on jobsite before the first inspection. If you intend to obtain financing, consult
attorney befar ornmencing work or recording your Notice of Commencement.
or - Owner Builder,�iicable
STATE OF FLORIDA
COUNTY OF /t2h< IH
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this it day of ^1 4R7 Jn 20 2Lby
Name of person making statement.
Personally Known V"�' OR Prod ced Identification
Type of Identification Produced KJA I vim` 5 L I c Q%Cs
(Signature of Notary Public- State of Florida)
Commission No. 4 H I039 (Seal) i +'"` N'otary Public Stele of Florida
x Rntx:rl M Rice
ly Commission HH 103595
Exrnres 04/03/2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
MANGROVE
REVIEW