HomeMy WebLinkAboutBuilding Permit Application (2) SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE 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:
Address: Add ress:
City: City:
Zip: Phone: Zip: Phone:
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 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
improv ents to your property. A Notice of Commencement m t e recorded and posted on the jobsite
befor a fir I spection. If you intend to obtain financin I
o with nder or an attorney before
com or recordingour Notice of Commen m
s
re of Owner/Lessee/Agent Sire of Contractor/License Holder
101,
STATE OF FLORIDAC�, STATE OF FLORIDA
COUNTY OF moi-. Qom, COUNTY OF sal-."we.n
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
thisday of 20 ]SS by this day of 20 VS by
(Name of person acknowledging) (Name of person acknowledging)
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Signature of Notary Public-State of Florida) (Signature of Notary Public-&te of Florida)
Personally Known OR Produced Identification' Personally Known OR Produced Identification
T e of Identification Produced Type of Identification Produced
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Commission No. (Seal) Commission No. ...... LASHAHNA INGRAM
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Revised 07/15/201 %re of r�o?Jc Commission #FF 177249
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Bonded throw h Assn.REVIEWS FRO PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS