HomeMy WebLinkAboutScan_20190710 (2)SUPPLEMENTAL CONSTRUCTION LIEN- LAW-- W FORMATION:
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:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRA OR AFFIDVIT.&L Application is hereby made to obtain a hermit to do the work and -installation as indicated.
E certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is grantingpermit will authorize the ermit holder to build the subject structure
h ich is in con list with any applicable Home Owners Association rule, bylaws or ang covenants that may restrict r- 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 a l I respects, perform the weak
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
conc rr ncyreuse : room
additions,
accessory structures, s i m m i ng pools,
fences,
wa II
, signs, screen roe ms a nd
accessory uses to a nother
n o n-residential use
"WARNING TO OWNERO. YOUR FAILURE TO RECORD A lI10TKE OF COMMENCEMENT MAY RE5ULT IN YOUR PAYlNC
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPEC110N. 1F YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER DR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:"
Signature of Owner/ Less
STATE OF FLORIDA
COUNTY OF
�6'ntractor as Agent for Owner
The forgoing instrurrlg.t as acknowledged before me
this , day of 20 by --
t
NL
i YYI. C�
Nhme of per Qr making statement.
Personally sonally Known OR Produced identification
Type of identification
Produced
(5ign 'arure of Notary Public- State bf Florida ]
"1
Commission Flo. � �Seal)
Signatu're of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrumgpLw s acknowledgeefore me
this_ day of. 2D� by
.XD I I il I J-P t M -C)
ar of pr ire g statement.
r
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida }
Commission No. � {Seal}
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 7_t4i
Notes Pu13l1C State of Flonda
athertne Donna Mahar, �C4
my omr•nI ion ` 3xp,-
Notary Public State of Florida
Catherine Donna Mahan
y Commissw GG 17 881
y