HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY, Not Applicable
Name: Name:
Address: Address:
City: State:— City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Nat Applicable BONDING COMPANY: —Not Applicable
Name: Name:
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.Lu
cl�ise,Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
t n conflict
whi 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 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 attomey before
commenciniz work or recording your Notice of Commencement.
15gr6ature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIA< STATE OF FLORI
COUNTY OF f1d COUNTY OF_
The foying instwent was acknowledged before me The.for oing instru;pent was acknowledged before me
9
th is,,, day of H L(J05-i 20joby this,W day of fit 0,6gt 20W by
co-maitte' l � -77"'I�_w-hgdC OaMoel
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary F Nota ryfubfic-Statgffltfti
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Personally Known Producification Personally Known 0 nti
Type of Identificatio" d Type of Identification ProduodSayy 0
Commission No. Commission No. a
. ........ .
NOVA!
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETE