HomeMy WebLinkAboutBuilding Permit Application (2) 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 TITLE HOLDER: _ Not 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. Lucie County makes no representation that is granting a permit will authorize thepermit 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 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 attorney before
commencing work or recording our Notice of Commencement.
Signa Owner/ essee/Contractor as Agent for Owner Signature of Contracto -66&e Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF LW STATE
COUNTY OF wC1E
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of20_\_�by this n'-'Lday of 20 by
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( me of p &son acknowledging) (Name of per on acknowledging)
6 AA A OAA
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Identification Type of Identiffication
Produced """ KAREN S. NIELSEN oduced (— --
'_° Commission# FF 115637 I'` o``:�"' KAREN S. NIELSEN
�c ��mmission Expires ommission No. ,� CoY n7g��A# FF 115637
Commission No. M C mmi
June 12, 2018 oc sion Expires
°;;; °� June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
7—
COMPLETED
Rev.