HomeMy WebLinkAboutBuilding Permit Application (2) 1 O
SUPPLEMENTAL{COIyS1�R�JC/TION LIENSL'AW}�IN�FORIVlAT10'M
✓i..t, ' 5 S f 1 J � 5. S �_k3 1;.".L. �...c`z ....S{�:s �'�Y,Li
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:- Not Applicable
Name: Name:
Address: Address:
City: State: City: 41 State:
Zip: ------ .:phone: Zip: Phone: + I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY:. L..4" Not Applicable
Name: Name:
Address: Address: t
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. Vt.
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�se
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 our Notice of Commencem
s
_Signature of O n Lessee/Agent Sign ure of Contractor/ i Brise Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MAP-%1+,-1 COUNTY OF M4T' 7',l
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisZyrff day of M J4 20 16 by this 7�day of /h 20 Z by
(Name of person acknowledging) (Name of person acknowledging)
natu f Notary P c-State of Florida) (Signature of 41"t
Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produce
�jJdention
Type of Identification P Type of Identification Produced ����
.PAN Notary Public Stabs of Flora.
Commission No. 'y Joshuaa(pf"9ioln FF210626 Commission No. ,i';��p AMA
My - hC
Expires 0411=019 _ �'- Motary PuDltc. UM d Flrroa
Commlrt
IF my Com
.at
111I1 U.2020
Revised 07/15/2014 goadirrtllUgn,p�,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I,