HomeMy WebLinkAboutBuilding Permit Application Page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x 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 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 t Irst inspection. If you intend to obtain financing, cons It with lender or an attorney before
commg work or recording your Notice of Commencement
_ 5 naCure df Owner Lessee/Agent
STATE OF Fl. A
COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me
this -ZA_ day of J81f1 Ua Y3 , 20 1& -by
Oil �
(Name of per on acknowledging )
(Signature of Notary Public- to of Florid )
Personally Known �OR Produced Identification
Type of Identification Produced
Commission No.
;rte'• BERLY MAY
MY COMMISSION # FF241,
EXPIRES June 18, 2019
or ti,,
Revised 07/15/2014 FbMallotaryServ" con,
REVIEWS I FRONT I ZONING
COUNTER REVIEW
COMPLETE
INITIALS
IA(
Contra or/License Holder
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me
this 2
A_ day of JclnUa ll 20 L by
ej
1eq
(Name of per on acknowledging )
(Signature Notary Public- tate of Flori a )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
mmission No.
SUPERVISOR( PLANS I VEGETATION
REVIEW REVIEW REVIEW
KIMBERLY MAY
CC�MI�AICCI� s�crr��,
EXPIRES June 18, 2019
;s98� 53 FIoMallotarySe�iice con,
ISEA TURTLE I MANGROVE
REVIEW REVIEW