HomeMy WebLinkAboutPermit, pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Af1fNl ri'\ / /.I1�TA a
W W"mr-n/ t ulm 1 KA%- I UK H1•11-ILJVI 1: 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.
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 Horne 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 1 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 a in t . f
improvements tc
Lucie County and
with lender or an
Signature
Y P IF wlce or
your property. A Notice of Commencement must be recorded in the public records of St.
posted on the jobsite before the first inspection. If you intend to obtain financing, consult
attorney before commencing work or recording our Notice of Commencement.
STATE OF FLORIDAj
COUNTY OF y �Q_
as Agent for Owner
SMorn to for affirmed) and subscribed before me of
OY sical Prewnce or Online Notarization
this �7day of. �_ 2020 by
IL RC4 P_ V uLQ"r'.Q_
Name of person making statement.
Personally known OR Produced Identification
Type of Identification
Produced
ignature of Notary Public- State of Florida )
Commission
014 to Pub3ic State of
Searnda Soto
V.o My Commission GG 1
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Contractor/License
STATE OF FLOR
COUNTY OF
_5t=r
Sworn to (or affirmed) and subscribed before me of
- Physical Pres or Online Notarization
this day of 1 2020 by
er- L �YY
Name of person making statement
Personally Known OR Produced Identification
Type of Edgnt;ification
ture of Notary Publit a
it lq !Votary ublic State of Rorda
fission No. Wagr4a SRto
C My a�Rt��,ls1on GG 184727
Expires 02111/2022
REVIEWS
FRONT
11111 11G
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
.!