HomeMy WebLinkAboutkirby loop 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
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City:
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Zip: Phone:
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vvvr10F.n/ a•wm i KA16 i unArriuvi i: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 exemptfrom 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 recording vour Notice of Commencement.
ture of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for� ing instrument was acknowledged before me
his f
t�foday of _ "�., L' _. 20_L�t- by
Name of person making statement
Personally Known ___4C R Produced Identification
Type of Identification
Produced
(Signpture of Nota r P b ' - State of Florida)
J4¢
Commission No. `� `��`'•- Notary PL'IfTI'cl- ARTIState 01 Florida
• •= Commission # FF 216951
MY Comm. Exoirss Ant 9 onia
REVIEWS
COUNTER I REVIEW I REVIEW
DATE
COMPLET
Rev. 8/2/17
Sig re of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 54 — J � _'_
The foring instrument was acknowledged before me
this 15" dayy'of � _ 20, by
fie J
Name of person m king statement
Personally Known �(�aOR Produced Identification
Type of Identification
Produced
{signature of Notary Public- State of Florida )
2UN
� V P q�s t4ARTIN
Commission No. s� (
Notary Put1IIC - state of Florida
•Commission FF 216951
ol �"Bondedthrough ationalNotary Assn
PLANS VEGETAf>L
REVIEW REVIEW REVIEW REVIEW