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5llPPLEMENTAL CONSTRUCTION LIEN LAW tNFORMATIOI
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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 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 ilur ord a Notice of Commencement may result" your paying twice for
improvements to your prop rty. o •ce of Commencement must be orded ted on the jobsite
before the fir I spectio f y i t d to obtain financing, consult i Ind o torney before
commenci w(irldir re rdi Notice of Commencement.
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Signature of Owner/Less a/Contr to as Agent or Own Si nature of Contralto cense o e
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF T L,_Z2r_E
The forgo' instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisf� y of SUi1�� 20/ ;'by this/ of ! U.0 201? by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature o Notary Public- ate of Florida)
Personally Known -,-, OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. GAUDNj Commission No.
MY COMMISSION# F173907 _ :+: ANN M, UM ND
+: _ MY COMMISSION#FF 173
°°' Bonded Thru tary Public Underwriters =+ oQ= ES:December 7,2018
of ,.•' Bonded Thru Notary Public Undenvrilers 19
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS