HomeMy WebLinkAboutfogg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
%0 vrlor-RI a.vry r nnry r vic Hrrtuvi l : Application is hereby made to obtain a permit to do the work and installation as indicated.
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 wilt 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,
accessary 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 your Notice of Commenceme
w
Si ure of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 4� t
COUNTY OF
The fo,rg1�o�ing instrument was acknowledged before me
this 3 day of _ , 20_a by
n
Name pers�on� Ing statement
Personally Knowny OR Produced Identification
Type of Identification
Produced
(Signature of Nota Public- State of Flo ida
Commission NO. `'-- MIKEP RTIN
otary Dubs a of Florida
Commissior 9 :,G 346354
My Comm. Expires Jun 19, 2023
nt.
Sign ure of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF _/+-<<' =
The forgoing instrument was acknowledged before me
this day of ✓►L 4 20_1j� by
' 3
Na a of ry persomaking statement
Personally Known �'" OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pub
Commission No.
.j riurraaiAIKERAYM MIN
�^ Notary Public - State of Florida
y Coftigf�n # GG 346354
My Comm. Expires Jun IS. 2023
Bonded through National Notary Assn.
REVIEWS
FRONT
COUNTER
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
ZONING
REVIEW
DATE
RECEIVED
DATE
CDMPLETED
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