HomeMy WebLinkAboutSignature pageSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER%ENGI_NEE W Not Annlirnhia
Name:_
Address:
City: — State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name;
Address:
City;
Zip: Phone:
l
MORTGAGE COMPANY;
N
NUt Applicable
ame.
Address:
City: State;
Zip: Phone:
BONDING COMPANY: `Not Applicable
Name:
Address: _
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nttoyy work or installation has commenced prior to the issuance of a permit..
cieCoun
kes
which is in confiictawith any representation
owgranting sssociat onResaby aws or and covenants that build
olrr p Structureih
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
'"ARMING TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWXF FOR IMPRovEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, FF YOU INTEND TO OBTAIN FINANCING, CONSULT
1'ITTII YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner{ Lessee{contractor as Agent for Owner
STATE OF FL IDA [,1
COUNTY OF FLORIDA,
Rcsa
The forgoing instrument was acknowledged before me
this day of 20 by
Shcn ��. o�we�s
Name of person making statement
Personally Known, OR Produced Identification
Type of Identification
Produced
JEANNE J. BROWN
Commission No.
Notary
dhState ofFlorida
Com ISSk GG 291649
My Comm. Expires Jan 16, 2413
REVIEWS I FRONT ZONING
COUNTER REVIEW
PATE
RECEIVED
DATE
COMPLETED
Signa€u re of Contractor/License Holder
STATE OF FLORIDA
COUNTY Of, •_7w(w Rosa.
The for oing instrumentwas a knowledged before me
this day of - ri 20� by
3KoA a. bweA-,
Name of person making statement
Personally Known G OR Produced Identification
Type of Identification
Produced
re of
Commission No,
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW REVIEW
Notary Public -ate Florida 1
Carnmissiw 1649 91
My Comm. Expires Jan 16, 2423
Jed through National Asin.
Y
SEA TURTLE MANGROVE
REVIEW REVIEW
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
PKOPOSED IMPROVEMENT LOCATION:
Address:
Property flax ID t#:
Site Plan Name:
Project Name:
f DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Permit Number:
Building Permit Application
Commercial
Residential
Lot No,
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank i Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing ^ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $
OWNER/LESSEE:
Utilities: —Sewer —Septic Building Height:
Name hoii Q^ 0 SP_U15
AddresslS yAwQt tf ^
C' State: FL
zip Code: 3 SIoS Fax:'sSt-3b7-0(-7
Phone No. i5so -2a
^Q
E Mail: ales a CA
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:_%nA
Company:
Address: 3a;
City: State;
Zip Code: SI`o� Fax: 6 -At 7
Phone No Qw 554.. ili I
E -Mail Malo l . C:a Ian
State or County License'Ay-C-15097%
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.