HomeMy WebLinkAboutBuilding Permit Application pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY:
Not Applicable
Address: Address:
City: State: _ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
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 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 antl 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.
Inconsideration 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 cancurrency 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Signature of Owner/ ssee/Contractor as Ag nt for Owner
STATE OF FLORIDA
COUNTY OF F.
The for oing instru ent' w1as acknowledge(1.pefore me
this day o��f//.' 20�15 by
Na of erson making sta eemmenntt — /�
Personally Known OR Produced Identification f
Type of Identification „
Signature of Contractor/License H (der
STATE OF FLORIDA
COUNTYOF
The for ing instr ent was acknowledge efore me
this,, 11day of LFI l� . 20Vby
C'�rYYV Pia i
Name of pe son nnalking statenirent
Personally Known OR Produced Identification
Type of Identification „„
(Signature of Notary Public -State of Florida
(Signature of Notary Public State of Florida I
KARE�y NIELSEN
Commission No. ••"""•
�a�,Il%FF n5a37
Commission No. •j' "
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My comm �s n Exn
KAREN
com _
. NIELSEN
1� 7
Junes 12 �2018
msson a FF 11563J
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June
2, 2018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
EGETATION
COUNTER
REVIEW
REVIEW
REVIE _
REVIEW
REVIEW
REVIEW
Rev. 8/2/17