HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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 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 the Florida Building
plans, 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 thp4irst inspection. If you intend to obtain financing, cons with lender or an attorney before
comm ci work or recording our Notice of Commencemen .
J
s
_ Si n ure o Owner Lessee/Agent Sign to of C tractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF INDIAN RIVER COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _ day of 20 _by this day of 20 by
MOW, aofperson I�(Name
of er onacknowledgin ) _(Name knowledging )
(Signatu of Notary u ic4tate �Ioriida ) !(ign4atuof Notary aPubl'�State ofFlon )
Personally Known 11_' OR Produced Identification Personally Known V-11, OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. __._._.._._15ea1) - mmission No.
KIMBERLY MAY ,:,�:%;;KIMBiERLY MiAY
x: PAY •- ION # FF241665
Revised 07/15/2014 ='� 2019
-��y EXPIRES June 18, =� EXPIRES June 18, 2019
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407. "5930,53 FbridaNOtaryservde cow X407; 393-0"53 Fb,id-aNFoiaySer w_e cow
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS