HomeMy WebLinkAboutSignature pageSUPPLEMENTAL CON'STRUCTION'LIE'WLAW INFOR`MATION:,. ,.
DESIGNER/ENGINEER:
— Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
FRONT
Address:
SUPERVISOR
Address:
City:
State:
City:
State:
Zip: Phone:
REVIEW
Zip: .-Phone:
REVIEW
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
COMPLETE
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 reviewyour 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 tganother 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 inection. If you intend to obtain financing, consult with len or an attorney before .
commencing4yor c�r recording your Notice of Commencement.
Signatu
as Agent for,Owner, Sign
STATE OF FLORIDA--e—
COUNTY OF
The forgoing instru e t ckn wledgMy
ore me
this ay of 20 .
(Name of person acknowledging)
(Signature -of N I
ary Public- State of Florida
PersonalVKhbwi t► i do
Type of`I�det� on P�odu&J�ELA M HUFF
_ a, otary Pub a e of Honda -•
Commission # FF y,pf
Commissignx 4 �c
- 11 '.'F1,�,o- ". res Ma 19'
Revised -07/15/2014
STATE OF FLORIDA
COUNTY OF 1 r,
_� C � -P _
The forgoing instrument was acknowledged before me
this day of 20 t � by
(Name of person acknowledging).,
�n\ /N A
(Signature of Not ' Public- State of. Florida )
n. (Personally
Type of Ide
Commission N
OR Produced Identification
ANgE
Notary p�qU41ic _ g t6.4
My Com mission ig cr o Flof
th�ou9h 1017a/n�aY 2I 201 g� -
'..a 4ss,7
- r
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER -
REVIEW
REVIEW
REVIEW
REVIEW ..I
REVIEW
REVIEW'
DATE
COMPLETE
INITIALS