HomeMy WebLinkAboutCottrell Permit App pg 2 001SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY-
Name:
Not Applicable
Address:
MANGROVE
Address:
COUNTER
City:
Zip: Phone:
State:
City:
Zip: Phone -
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 wdh 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recordine your Notice of Commencement_
Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder i
SPATE OF FLORIDA S f( i i GL STATE OF COUNTY O FLORIDA a. La6p,
6p,
COUNTY OF w� WL
The forgoing instrument was acknowledged before me The for oing instru t was acknowledged before me
this �t"day of �� . 20 B by �� this day of u�__, 20. ydhy
�Al GV LcP P � 60*' Ni ckaer f 13OVI&
(Name of person acknowledging) I (Name of person acknowledging
(Signature of Notar (�ublic- State of Florida ) (Signature of Nota"blic- State of Florida) /
Personally Known V OR Produced Identification Personalty Known OR Produced Identification
TypJld' P - Type of ld
,CHRISTINE J. COCHRISTINE J. CONWELL
Comgo . Sta{F9PI�or10a Commissi _ 4 Notary Publk - State {1i19dilfa
'ommission N GG 017839
Commission M GG 017939 ' My Comm. Expires Aug 21 Ima
_ _ Bondeo through National Notary Assn.
"" otnrougn NHigny NotaryMM.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS