HomeMy WebLinkAboutimg-160122022509SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
BONDING COMPANY: X Not Applicable
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. P:ion
ase consult with your Home Owners Association and review your deed for any restrictions which may apply.
Y PP Y•
onsideraIn cof 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
commepcing work or recording your Notice of Commencement.
_ Si"ture of Owner/ Lessee/Agent
STATE OF FLORIDA rr /
COUNTY OF
The forgoing instrument was acknowledged before me
this �3>1 day of a,-) i4 20 Lby
(Name of per on acknowledging)
(Sign0` re of Notary Public- State of Florida )
Personally Known OR Plo�LuFAd Identificatjum _ _ !
Type of Identification Produced h,,,)A ,,,,USA
Commission No.
Revised 0/15/2014
ature of Contractorlticense Holder
STATE OF FLORIDA j k�;�
COUNTY OF
The forgoing instrument was acknowledged before me
this, day of 20/2__by
(Name of person acknowledging )
lgnature of Notary Public- State of Florida )
rs n ly Known OR Produced Identification
pe o dentification Produced
Notary Public - State f f Florida
7y Comm. Expir,,5 ".ta 1t4ogpryrgi sion No.
Commission # FF 071680
Notary Public - State of Florida
Commission # FF 071680
Bonded Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:T
City:
Zip: Phone:
FEE SIMI
Name: _
Address:
City:
Zip:
X TITLE HOLDER
Phone:
X Not Applicable
State:
X Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify thatl no work or installation has commenced prior to the issuance of a permit.
X Not Applicable
State:
X Not Applicable
St. Lucie Countyy 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. PI@ase 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
cgmmencing work or recording your Notice of Commencement.
s
Signature of Owner/ Lessee/Agent
at of Confractor/License Contractor/LicenseHolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1/J�j� COUNTY OF_ 11,IZ-71 t'
The forgoing 'instru ent was acknowledged,before me
this, day of20 J& by
The forgoing instru nt was acknowledged before me
this, day of 20 jCv by
36�6? dywa
zlwo 4'elme-s-
(Name of person acknowledging)
-
(Name of person acknowledging)
(Si re of ;Nota Public- State of Florida)
-
(Si ature of Notary Public- State of Florida )
P rson OR 'o
Personally Known r
Type of Identification Produce o�;�p•p°••,
a •
Identification Prod ed� ���y��,,SANDRA HOHMANN
�.`�
_ Notar
c • « ° Y Public - State of
Commission No. cN o �1� Comm. Expir
F =r°a. No Public -State of Florid
'ssion No. °. • ; ._ M�Qg Expir s 'ar 14,20
, ar 1BOA
Commission
�"""jDBonded FF 07
.2 .
018 � l'� Commission # FF 071680
680
Naiienw
' • Bonded Throu h National Notary As!
sn.
Revised 07 15/2014
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS