HomeMy WebLinkAboutPine View ApplicationSuPPLEMENTALCONSTRUCTION LIEN LAW INFORMAT loN:
DESIGNER/E NGINEER: jL Not Applicable
#a°mReT.GAGEC°MPANY: |NotApp|icab|eName,
Address:Addres¥.
City: State:City: state :
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable B0NDING COMPANY: Not Applicable
Name:Name.
Add ress: 26532 E STATE ROAD 78 Address.
City:Ci.
Zip: Phone:Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: 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.
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ln consideration of the granting of this requested permit, I do hereby agree thinaccordancewiththeapprovedplans,theFloridaBuildingCodesandSt.Luciat I will, in all respects, perform the workeCountyAmendments.
The following buil ding permit applications are exempt from undergoing a full c oncurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another nan-residential use
WARNING TO OWNER: Your failure to Rei?iorfe:inhT::fi:rts;t#p:ef:p:rf.rp#y#uTreo#t!c
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of Uwner/ Lesse`e/Contractor as Agent for Owner SignlaiEre ofTontractor/u.cense Holder
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personaH#:£:Per:::rpz#:8r:t:::deindtentification perso=a,,#:wofp_er#pgr::aut:emde,:tentjficatjon
Type of Identification Type of IdentificationProduced ~ /\Produced r` A
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`(sig ureofNo inbljed ateo orida) `(H ture ` f R¥'ic-`StatTof Florida )-I-Ill- ,
Co TIFEAV RENEE DEWCOwMISsloN#GEXPIRES:July31.aondedlhrliN^talvhihihi
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RENEE DENTONMMISSION#GGZlPIRES:July31,2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
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-S-EATURTLE
MANGROVECOUNTERREVIEWREVIEWREVIEWREVIEWREVIEWREVIEW
DATERECEIVED
DATECOMPLETED
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