HomeMy WebLinkAboutBuilding Permit Application SURPLEMENTAL CQNSTRUGTION LIENa,LAW 1NFQRMATIaN ? N
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:
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
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
commencing or or recording our Notice of Commencement.
s
_Signatu of Owner/Lessee/Agent Signature ontractor/License Holder
STATE OF FLORIDA tt, STATE OF FLORIDA
COUNTY OF LCOUNTY OF •UC�_c
The foroing inst ument was pcknowledged Fbdore me The forgoing instrument was acknowledged before me
this day of d 20 [,�>_by this 2):Dday of 20 �by
KYLE WHITE KYLE WHITE
(Name of person acknowledging) (Name of person acknowledging)
\\1\111iiidillly��i
(Si nature of Notary Public-State of FI ...•�SQ• •.s9 Gig (Signa re o Notary Public-State of Florida
G°�'nar rsA'• �% \N�\\\il��NNtillrf�i�s/'i
Personally Known OR Produced Id rit icatroit'o.9�„: % Personally Known OR Prodv�t S
Type of Identification Produced * _ ..... S°�'`*= Type of Identification Produced •• ���S—mss,
r t #FF 936050 ..
Commission No. —I 5b 5'e ��gd�N S�Qo\` Commission No.yFgt,`3 augtuq S�,,al}� N�*
S o: #FF 936050
�1Hlllllli111\\ ii gyp••. �'ledfi s;•^•,��
y�yo•.�NotarySec�:• O`�`��
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS