HomeMy WebLinkAboutimg446SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
Name:
Address:
City:
Address:
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,
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 th cony* inspection. If you intend to obtain financing, con�with lender or an attorney before
commoKink work or recording your Notice of Commencemeoe /
/Lessee/Agent
STATE -AF -FCO R I DA
COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me
this °I dayof_OCtr n(, r 20 11by
0'Q�-1 omfu
(Name of person aFkn ledging )
(Signatihe of Notary Pwlic'State of Morida )
Personally Known �R Produced Identification
Type of Identification Produced
Commission No
KIMBERLY MAY
N # FF241665
Revised 07/15/2014 EXPIRES Jure 18, 2o1s
�4c''i! 3`38.0'53 FlordallotaySe—ce.com
r
/License Holder
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me
this 9 day of O Gi �> b t' r 20 L by
Me, L,
(Name of person acknowledging )
(Signature f Notary Pu Ic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
_ZM� 1 FtLY MAY
MY COMMISSION # PF241665
'"�•,,;e�.' EXPIRES June 1�f6i3'-
14Mi 398-0+53 FloridallolalySelvice.con'
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE MANGROVE
REVIEW REVIEW
D ATE
COMPLETE
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INITIALS