HomeMy WebLinkAboutBuilding Permit Application Sep 231610:33o Jensen Beach Plumbing 772-225'8779 p2
Sep 23151O:33o Jensen Beach Plumbing 772-225-6779 p.3
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: Address.
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lu cieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conwict with any applicable Home Owners Association rules,bylaws or and covenants that may festrict 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 concurrencV 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 paVing 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
r-commencfng work or recording your Notice of Commencement.
—Signature of Owner/Lessee�A� -Signature of Contractor/U�ense Holdir
STATE OF FLORIDA STATE OF FLORIDA
The forgoing instrument was acknowledged before me, The forgoing Instrument was acknowledged before me
this.2j day of ac�[6mlao.K 20 L.IT-by this o73 day of v- 20 1-5 by
(Name of person acknowledging) (Name of person acknowledging)
ure of Ni5tary Public-State of Florida (SIture of Ndtary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced T pe of Identification Produced ...................
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE