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SUPPLEMENTAL CONSTRUCTION LIEN-LAW INFORMATION:,.
DESIGNER/ENGINEER: _Not Applicable MORTGA SE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: FL City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDINE COMPANY: 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 author a 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.
I consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
i I accordance with the approved plans,the Florida Building Codes and St.Luci County Amendments.
The following building permit applications are exempt from undergoing a full c)ncurrency review:room additions,
alccessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements to your property. A Notice of Commencement mu t be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,cons It with lender or an attorney before
commencingwork or recordingour Notice of Commencemen
Signature of Owner/Agent/Lessee Signature oi Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST ".C_16' COUNTY )F--S=k c ICE
The forg�Ug instrument was acknowledged before me The forgoin instrument was acknowledged before me
this 2�day of 'Tu c% . 20!Irby this�d y of
�4ft1 ���� INYNr�+Gs A l C=
(Name of person acknowledging) (Name of p &son acknowledging)
((Signature of Notaryl Stat
ic-State of Florida) (Signature f Nota Public- e of Florida)
Personally Known .//OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Identification Produced
ii��?��••.,, DOROTHYANN BASKIN
s °Y4'� N
Commission No. .�: MYCOMMI #GG 030145 Commissio No :':j��� .r, DOROTHYANfG�g
o EXPIRES:October 2,2020 ;;; ;.r OMMISSION#GG 030145
P Bonded Thtu Notary Public Underwriters EXPIRES::Octob
N o�ry Public Unde
rwrifers
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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