HomeMy WebLinkAboutScan 1 SUPPLEMENTAL CONSTRUCTION LIEN LAW IN FORMA11ON:
rFWGFIERIENGINEER= Not Applicable Nf1lRT(iAEiE 013MPd4NY.- - _ Mat Apphcf
Name: Name:
Address: Address;
CIty: Gty: - State, _
zip: -Ph€ne..
FEE SIMPLE TITLE HOLDER, ,r A e BONDING COMPANY: Not Applicable
Name:—_ Name;
Address: -- Address:
City- City:
Dix Phi dip: Pho Tizr:
OWNER/ CONTRACTOR AFRI)VITAppkation is hereby made M obtain a permit to do the vrerk and installation a5 i;d icated.
C tertify that no work-pr ir nation has cprnmenced prior to the i3suame of a permit_
St.Lucie County n aktLs rto reprrsenration that is grar"nE;p pt-rmit will authgaize the permit holder to build the subieet upcEure
whit is in ocmfllict with;)ny mppliratkfe Home Oh ows Assoclati€h rures,Wawvs tar and covenants that may rpstri€t or prohib4t;.licit
stmicture_Please❑umuit with your Ftomr Owners Aswduftn and neviexw your deed for any feArietions which may apply.
IYL ebrisiderat1cm of the granting of this requested permit,I do hereby agree that II will,in all respech,perforr'n the:w ark
in acco€daftee with the appro,red pfans,the Frg)�rida Mi 0ing Cod St.Lucie County Amendmeirits_
The followirpg building perfmtt aipplicatit ms are exempt from undergoing a full wncurrencyr rewtew:room edditic,ns,
accrFmmiTY sbi fures,,'7YVimirninE pcols�feo e5,walls,Suns,screed toorms and wxLm.oryr usa:to anathrr.ron-residential use
V AmiNG TO OWNER.Your falttre to R ;b N *(lWirnmiencenrieFIrt rroy resuft in VDLw paying twice for
irnpro+vernants to your property, A Notice of Cbrn rtencernent m ust be recorded and Posted On the jobsitc
before the first inspection. di you irter)d to amain fnartcang,curnvlt vrith leakier reran attanrfeyr he-fore
camrrpertdng work or record , your Nattoe of CxNnmencenimt
•- T--- - -
Signature a Owrre rr'I.C^ or as Agent for Owner Signature of er
STATE OF F A � f r STATE OF FIL ACOOLvialry r
The# r 'ram infre me The 4rf �nowledefor�c me
fday+�I ' this - + ,. e by
Name,of p)rF.bn making st3 rineryt_ Nanve of person iv&ir,g statement.
Personally Known r OR Produced Identiliscatipn Personally Knows, OR Pra+Ju.L*d 1dentiTkAGDn
yw of rrrleaffica6wt Type of Idcntificzticm
Pm dumbd I Pr+duCes#
it
S51Krtatu re of Not_ w-Nos$eV Public ll �8f v F R ES N I LL
,�' s; i�rl7-is" Or,4 Gas 2727d7 �, � Sieiie W Flbridu-Notary+ Public
,T C� mission No' ���t i t s- #�ir�r+ F xplrgg C�ilitiii�Sao�S Nam_�d.,`� IS 272747
DeLa-nhnr 22. 2022
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RUICWS FRONT BONING SUPERVISOR PLANS VEGETATION SEA TURTLE h1,AliSAO
COUNTER REV"*w ft'}ydit%r RFVIFW ITIEVIUN P4VIEW REVIEW
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