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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNFR/ENGINEER:
,
— Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
State: CitY: � State:
City:
Zip: Plior�e
_ pho e:
Zip:
FEE SIMPLE TITLE HOLDER:
_Not Applicable BONDING COMPANY: —Not Applicable
Name:
AAA--
Name:
\ Address:
Zip- Phone: I Zip: crone: _�
OWNER/ CONTRACTOR AFFIDVIT- Application is hereby made to obtain a permit to do the work and installation as indicated
1 certify that no work or installation has commenced prior to the issuance of a permit.
makes no representation that is graining a permit will authorize the permit holder to build the subject structure
St Lode Caun
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 concurency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
'WARpMIIG TO OWNM YOUR FAILURE TO RECORD A NOTICE OF COMMENC.E]MENT MAY RESULT IN YOUR PAYING
twm-s van ncnnrsKaxrs TO 7OIRY PROPERTY. A WnCE OF COMMUdCElMFN'r MUST BE RECORD® AND
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