HomeMy WebLinkAboutSupplemental Construction LienApr 13 2022 9:41 am
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. Luc-e-06U'hty
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DESIGNER/ENGIN
ER: Not Applicable
Name:
VA '
Address
City;
State:
Zip:
Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City_
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address: IVA
City: State:
Zip: Phone:
BONDING COMPANY: ^Not Applicable
Name:
Address:,
City;
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 makesnorepresentation that is granting a permit will authorize the permit holder to build the subject structure
structure. �Please consult with yourr Hormileowners Association and re ie your deed for any restrictions wh ch may p apply.
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 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
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
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Signature of Contra r - or - Owner Builder as applicable
STATE OF FLORIDA 16f l c�
COUNTY OF
Sworn o (or affirme ) and subscribed before me of X Physical Presence or Online Notarization
this I� day of ,Gl L 20r12-by
Name of person making statement.
Identification
Personally KnownA'P;"r0d//-OR Produced
Type of Identificauced
'(Signature of Notary Public -State of Florida)
. RD
lms FEE
Comml SA A ft., I., (Seal)
a a State of Florida
yx Comm## HH177765
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S�NCE 19� Expires 9/22/2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 16/12/E1