HomeMy WebLinkAboutBuilding Permit Application SUPPCEN��rNTAL CONSTRUCTIQN LIEN LA,1N lNECiRMATit�Nz j -' t � �` u`' ''� � 'F=��3 �`'
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: i Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable'
Name: Name:
Address: Address: I
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 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.
_Signature of Owner/Lessee/Agent Slgnat of Contractor/License Holder
STATE OF FLORID STATE OF FLO
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COUNTY OF COUNTY OF 612g�G
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The forgoing instrument Was acknowledg4before me The fo oing instrument}�vas acknowledged before me
this day of_t .;Y20by this day of t �f- 20 by
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\ ,rfr)L� J b i i a ;
(Name of person ackn wledgin (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signatur f Notary Pu lic-State,&Florida)
Personally Known Personally Known OR Produced identification
Type of Identificati n,iior' ed 9ngk� Type of Identification Produced
Notary Public State of Florida
Commission No. Commilllo( )20732 OSA�..�.;f�li ANGEl�1yG
Commission No.
My Comm,Expires Oct 1,2022 , * MY COMMISSION#FF 951069
EXPIRES:April 12,2020
QFf40 BWed Riru Budget Notary SerAws
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INlTlALS
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