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SUPPLEMENTAL CONSTR
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
❑ Y: State CdV: state:_
ZIP: Phone Zap: Phone:
FEE SIMPLETITLE HONER; _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address-
City City:
Top: Phone zip: Phone:
OWNER/CONTRACTOR AFFIOWT:Application B hereby made In obtain a server to do the work and insts'labon as inaimatee.
I cerffy that no work or Retallation has commenced prior to the issuance of a Permit.
wl WnS Coon r�makes not rest tlm that is Rating a permit will authorize the emit holder to build the subject structure
Nucture.meaioncrinvee[onmlt wyH your Home OwnOwnersr soc Association and rules, pear deed for arty resaws or an c
investoGtrictions which may or prohibit
In consideration of me granting of this homexted Permit,Ido hereby Russ that l will,in all respects,perform the work
arsoMance with the approved plans,the Florida Building Codes and St,Lucie County Amendri
the following burkerig abol apWkations we erenpl from a/uN commissary review most addtlam,
spry structures swimming peal;fends,walls,signs,ormen
s and accexsry uses to another non-revdennal use
WARNING TO OWNER:Your(allure to Record a House of Commencement may remit In Wying twke for
improvements to your property.A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection.If you intend to obtain financing,consult
with lender or an attorney before commencinur work or reconfine your Notice of Commencement.
e
slgnamreof UxnerTLessee/COmraR«axf yem forowner Slenamreof fn acmr/smense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF if r ale 4 COUNTY OF tt- Lour
Swam to he affmlep and subscribed before me of season to for afNmedl antl suirvaged before me of
d Physical Presence or—online Notadaatbn oC Physical Presence or—online Natadption
this_bdayal 20311.by wki s—dayof C. .20111 by
ISgar R.a.« IcmC &..
Name Of person makNg statement Name Or Person m a king statement.
Personally Known d ORPrommudidentifiOHOn_ wersnilry K00 OR Produced ltlentiRcation
Type of gentmcation Type of ldemificadoo
Pmaucea Produced 7�
(Signature of NWry rt=SateIN nMurebNo Ic-SU4 a(RondaI
KIAPPA B a w ROP Comm elAARAus" PS FIGII
Commission No. ] Mk sle]Oe commission eo wGam nExp _ - Coco xa HXrl
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REVIEWS REVIEW
SUPERVISOR PLAINSREVIEW
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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