HomeMy WebLinkAboutPermit App Pg 2SLIPPLEMENT.ALCONSTRUCTION LIEN LAW INFORMATION
DESIG N E NGI NEER_ _ Not Applicable
�d�dFeS�:
City:
Zip;
State: �
Phone
MORTGAGE CONtPANY. Not Appficabfe
Name:
Address:
City: State, -
Zip; Phone;
FEE SIMPLE TITLE HOLDER. _ Not Applicable BONDI NG OOMPANY, Not Applicable
Name: Harne:
Address: Address
City: City,
Zip: Phone: Zip: Plines
1- . _ _.
OWNER/ CON+TMCTOR AFFIDVIT. Appkawn Is hereby made to obtain a permit to dG the work a W Installatlon as Indkated_
I wrty th-at no work or installation has cuRnnaenced priow to the issuance of a permit.
5T. Lucie Courtlyy ry%akqL& fact mprtrnkniun that F.55 Emrrting a permit wrtll asuthcwia:e the permit holder to build the subject lnawe
w.+hli a is In comHiCt wnh 815�,r ap awe Home Ow°rws�,�„u�to�n ruii�, bylaws -pr and oovc=ln'th�# may rtytr�fi kw pn;Auhir �dt.
Et w
structure, Please consuyour Home Owners Association and reView, your deed fof.any resbridWm, which may apply.
In consideration ofthe granting of this requested permiT, I do hereby agree char I Wilk ifi aII respe�tts, prrlorm the work
in z,)rdawe with the approved plans, the Florida BmIding Codes and St. Laicie county AmendrnerrU.
The following bu'ildinE permit appkations are exermPt from undergoing a full conwrrency review! foam clition.
accessory structures, swt mming pooK fey wslly signs, ;,rrt^r..n rp srn sand acces5ory roses to another non-residentia' use
—WARMNC TO OWNED YOUR FAM-LRJE TO RECORD A NOTICE Of CO MIMUWJ AIENT 1464 RE511MY IM YOUR PAYIMC
TWICE FOR IMPROVEIEWF5 TO YOtM PWWFRTY. A NOTICE OF COMMENMMElff MUST 19E RECORDEU AND
POSTED ON THE aDs SnE szFORE >rjm Fi ass wspEcmn- IIF You ®II rom Tu aur m FRAMING, CO#JSULT
Tum YOUR LE ER DR AN ATTORNEY BEFORE RECORDING "YOUR NOTICE OF C MIIEFyCE1M1ENT_"
S',matur�r -uf
WATEOFPMMA
OWNTYOF
as Ar—erittorOWriier f,11 5 ature
The forgoing instrument was ac ed before rite
this 11711day of --". 20z—c' by
Name of person making statement.
STATE OF FLORIDA
COUNTY OF
FI�Idrr
The forgoing Instrument was acknoWedged before me
the day of 20 by
Mpmicof perapn rmking.slat-i mr..nt_
PersonalIV Known OR Produced Identifeatiion PersonaltV Known OR Pmduccd IdcMifimtiQn
Type 4f Ider+tiFcatic?n Type of I`dEentlf caitlon
pr:uced 9+ C ire C -C Produced
e of Notary public- SZace of Florida �
iCommissbri No_
REWE4, 5 FRONT ZONING
COUNTER RIVIEW
DATE --
DATE
(Rpature of Notary Public- State of Florida }
Comn fdsFon No_ (Seal)
SUPERVISOR R I PLANS REVIEW V IES N I S � TLI MANGROVE
,AN MEW ER�YE