HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not
Name:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Personally Known
Name:
Address:
Produced
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, l do hereby agree that 1 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
rnmmencine work or recording your Notice of Commencement.
Signature of Owner/ en�nl.essee II Signature of Contractor/Ucens&Aolder
STATE OF FLORIDAS I I t �� I STATE O OF w rJ �
COUNTY OF
The forgoing insttument was acknowledged before me The forgoing instmentry � Sas acknowledged before me
this �dayoffkl l& -t- .20�by this wdayof'.yA'1"1'f�.t` r 20__1I
12
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota ubiic- to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Notary Public - State o1 Florida
8r' My Comm. Expires Aug 21,
,
Revised 4N Of Bonded through National N.
Commission o. nn„ uI STINE J. dfl
;°A,��s Notary Public -State of Florida
My Comm. Expires Aug 21, 2020
Bonded through National Notery Assn.
REVIEWS
FRONT
COUNTER
(Signatureof Notary7%!:Se
of Florida )
Personally Known
roduced Identification
Type of Identification
Produced
Commission o. nn„ uI STINE J. dfl
;°A,��s Notary Public -State of Florida
My Comm. Expires Aug 21, 2020
Bonded through National Notery Assn.
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS VEGETATION
REVIEW REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS