HomeMy WebLinkAboutBuilding permit app page 2Name:
Addre�
City: _
Zip: _
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Phone:_
1CIION LIEN LAW INI
_ Not Applicable
State:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the Issuance of a permit. no
— Not Applicable
_Not Applicable
Lucie County makes representation that is granting a permit will authorize the perm
w any
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,
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 recordine vour Notice of Commencement.
_ --- _----_ _� 5
_ Signature of Owner/ Lessee/Agent Signature o rac or License Holder
STATE OF FLORIDA
CO U NTY O F mma� aroa,
The forgoing Instrument was acknowledged before me
this_dayof September zo 20by
Amanda Ruan
(Name of person acknowledging )
STATE OF FLORIDA
COUNTY OF maian nma
The forgoing Instrument was acknowledged before me
this 3 day of September 20 20 by
Amanda Ruan
(Name of person acknowledging )
(Signature of Notary Public- State of Florida ) (Signature of Notary Public- State of Florida )
Personally Known x OR Produced Identification Personally Known x
Type of Identification Produced Type
of Identification
Commission No.
Revised 07/IS/2014
4ZSOZ0 00 N uolsslwwop
NVn2i tlONtlWtl
No.
OR Produced Identification
OZOZ'S �egweidas
R171Y.6GPG/h1�/
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS