HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INF0RI1IA1"l N';—
Name:
EER: Not Applicable MaR7 Not Applicable
Name:
Address:
City: State:
Zip: phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip:.
i��
Address:
City: state:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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,
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 financin& consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
-' s
ature of Owner/ Lessee/Agent Sighffure of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTYOF
_ __X - e COUNTY OF
The forgoing instrument w acknowledged before me The forgoing instrument was cknowledged before me
this day of r 20 Eby this day of '�✓ t 20 by
(Name of person acknowledging) (Name of pers n acknowledging)
r1l� as h
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known t/OR Produced Identification Personally Known Produced identification
Type of Identification P dLLrpd Type of identification Prod ��+�+■
""r`"n"'+•,, MIKE MARTIN
MIKE MARTIN �tr�"'a
Commission No. ' �+._ NotOp�lle - State ogAssn. Commission No. sr 4 49% iiblic • Stit! a! Flotl
Commission a FF 21Com lssion # FF 216951
,� My Comm. Expires Apr 5, 20
laffimmw
BoNoonal Notary Al
nded through National No
Revised 07/15/201
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