HomeMy WebLinkAboutBolinger-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:
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 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,
accessary 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
commencin ork or recording our Notice of Commencement.
s
_Sign re of ner/Lessee/Agent Signatufe of Coutr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S V LA r.t l COUNTY OF S'T L.u'c"
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 -- by this day of 20 by
4Ir" C 10c 5 rz t fj r am° N C S - 41
(Name of person acknowledging) {Name of person acknowledging)
t
(Signature of Notary Public- of Florida l (5ignature of Notary Public-Stat orida)
Personally Known OR Produced Identification Personally known OR Produced Identification
Type of Identification Produced Type of Identification Produced
�i nTNER RING ATIBER RING
Commission No. (h MM1S5ION N FF140529
Commission No. SSION9FFI40529 ��� EXPIM:MY10,2020
orr E)CM.ES:July 10,2020
Remised 07f 1112111
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
BATE
COMPLETE
INITIALS