HomeMy WebLinkAboutpermit application page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 recorciing your ivot+ce or (-ommencement.
Signa ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contr for/License Holder
STATE OF FLORIDA 9 J
COUNTY OF
The f rgoing instru nt was
p -acknowledged before me
this day of 20 jF7by
Personally Known OR P ��}dentificatrdtii( ,"enl a
Type of Identification Produci•11310
Commission No.
Revised 07/15/2014
Expiry ; 4,:
)�Onded 1hru "4aron
STATE OF FLORIDA CL J le
COUNTY OF
The forgoing instrument v� as a nowledged 11 fore me
this day of 20 1 /by
(Name of person ackpevVledging
(Sigfigture of Notary Kiblic-Stal-e f Florida )
Personally Known✓d Identifi�}�fiu�mmoia
ape of Identification ProduCr
; Commission # G 1
Expires: May 4, 2021
mmission No. :%` t 4b rani Aaron Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS