HomeMy WebLinkAboutBuilding Permit Application (2) SU:PPLENIENTAL CONSTRUCTION LIEN LAW INFORMATION: =
E .-. 1 . ,
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:
Ad d ress: 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,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
commencing work or recording our Notice of Commencement.
C t /� e C`- // � S
Si nature of Owner/Lessee/Contr r as Agent for Owner 31giiature of Contractor/License H
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF y LuJ
The forgoing instrument was acknowledged b fore me The forgoing instrument was acknowledged before me
thi day of 95-C 20 by this day of rt L 20 _by
(Name of person acknowledging) (Name of
of person acknowledging)
(Signature of Notary Public-State of Iricla) (Signature of Notary Public-State f Florida)
Personally kn9wn OR Produced Identification Personally Known OR Produced Identification,
Type`44clentificatj Mcluce OLA.WEAGLE Type of Identification Produced 72
,•.«.� Conrnission GG 196531 _rUUWXWEAGLE
Cotmnissionf
Commission No 1� EMAmApd�j ) Commission No. �( o
4o r- - iabedTh,oQu�patN,Wysarbes et E ApriSrZ02Z.
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Revised 07/15/2014
REVIEWS' FRONT ZONING' SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS