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:
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 thepermit 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 work or recording your Notice of Commencement.
re of Owner/ Lessee/Agent
s
ture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �5V a COUNTY OF 15 A -- Z—,, •' A
The forgoing instrument waq acknowledged before me The forgoing instrument was acknowledged before me
this'30 day of —r4- 20 1U, by this"JC day of 20 by
5 C_J " . -) r -*1 'Z" 5 c --\. C "J r-1
(Name of person acknowledging ) (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known
Type of Identification
Commission No.
Revised 07/15/2014
Produced Identification
.Na Ne -:1•M M NNW
Commtisisloe 1 FF 911111111511
My Comm. Expires Apr 6. 2019
in I through National No"AM
ntw n_ V
(Signature of Notary Public- State of Florida }
Personally Known OR Produced Identification
Type of Identification Pr
MIIC� IIIA
,Commission No. No"e"Ia - State of Flom
Commission # FF 216951
My Comm. Ex{),i : s, 2010
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS