HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTA#.CONSTRUCTION LIEN LAIN iNFORMATlON k.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable f.
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable r
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 consultwith your Home Owners Association and review your deed for any restrictions which may apply. f
In consideration of the g-anting of this requested permit,I do hereby agree Lhat 1 will,in all respects,perform the work `
in accordance with the approved plans,the Florida Building Codes,and St.Lucie County Amendments.
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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 yojr 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
S2X.Mencing work or recording our Notice of Commencement.
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Signature o Owner/AgEnt/Lessee Signature4of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 45-f -L.t1m COUNTY OF !NT -LQ A
i The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me F
this day ofOCDC=[Cv; 20LL by this�1pday ofQOL-T!C 1 2019by
(Name of person acknow. (Name of person acknowled 'A&C ,
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(Signatureaf Notary Public-State of Florida i (Signature of Notar ublic-State of Florida)
)
i Personally Known IN,,; —OR Produced Identification Personally Known JVJ OR Produced Identification
Type of Identification Produced Type of Identification Produced r
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Commission No�IE 11 `� qc�: (seal) Commission No. (Seal) "{
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]2016
� SHAWN ARUSSELL
Revised 7 SHAWN A RUSSELL ?z; ;" Notary Public-State of Florida
Notar Public-State of Io " ;My Go m.Expires Mar 3, �;'foF Lo¢,.` Com fission#EE 37808
REVIEW %r;o rIT Co r�iOMMb�iEE 37 tISOR PLANS V'g'( E`�ATION SEA TURTLE NGROVE \
W REVIEW E E RVI VIEW
DATE
RECEIVED
DATE
COMPLETED { �4----L____ _�