HomeMy WebLinkAboutRodabaugh app pg 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN GINEER: Not Applicable IVIORTGAGE COMPANY: Not Applicable
Name:Name.
Address.Address.City: State: -City: State: -
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:Not Applicable BONDING COMPANY: Not Applicable
Name:Name.
Add.Address.
City:City:
Zip: Phone:Zip: Phone:
OWNER/ CONTRACTOR AFF IDvm Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installatio n has commenced prior to the issuance of a permit.
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n consideration of the granting of this requestednaccordancewiththeapprovedplans,theFloridpermit, I do heraBuildingCodeseby agree thaandSt.Luclet I wlll, in all respects, perform the workCountyAmendments.
The followlng bulldccessorystructur in8 permit apples,swimmingpications are exools,fences,waempt from underlls,signs,screengoing a full concurrency review: room additions,roomsandaccessoryusestoanothernon-residential use
WARNING TO OWNER: Your failure to Rec#:pi:::vf:in::ty:t:s:t?#s:t:en3er#:h?rjeoA::i
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Name of person making statement.
Personally Known I/ OR Produced Identification _
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
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