HomeMy WebLinkAboutLeeter - Related To PermittingSUPPLEMENTAL CONSTRUCTION. LIEN LAW INFORMATION:
DEM ENGINEER: _ Not Applica
MORT COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Z' Phone:
FEE SIMPLE TITLE HOLDER: _ Not
BON MPANY: Not Applicabl
Na e:
IN
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 ult in your paying twice for
improvements to your property. A Notice of Commencement must be reco d d and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult h er or an attorney before
commencing work or recording your Notice of Commencement.
/' 0 , , Y_ I, �'2 , ) e=:: �: �
gig � j Lessee/ -ontra �vn-_ e
STATE OF FLORIDA
COUNTY OF FLORIDA
The famoing instru t a knowledge efore me
this day of - l 20 by
Name of person making statement-
Personally Known OR Pro uced Identification
Type of IdentKi atpn
(Signature of Notary/Pq liq State of Florida )
(Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
of Cgntractor/License Holder
STATE OF I
COUNTY O
The forgoing instrument was acknowledged before me
this 1A day of O`fD Cr' 20-0 by
Aliat, Reid
Name of per4pn making statement
Personally Known OR Produced Identification
Type of Identification
Produced
�i nature of NcWa Public- Stat o i a
(g ry C 6� �� S"
°r.�;.Notary Public -
Commission No. C-160 Ole • al Commission N
LY Comm. Expires
'���•;;�OF_c;°pr Bonded lhroughNatio
SUPERVISREVIEWOR I REVVIEW NS I VEGETATIEVIEWON I S EV EWLE I M EVIEWVE
2020
Assn