HomeMy WebLinkAboutBuilding Permit Appl Page 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
MANGROVE
Name:
COUNTER
Address:
City:
Zip: Phone:
State:
Address:
City:
Zip: Phone:
State:
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 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 work or recording your Notice of Commencement.
v — - - - C_—- s
nature of Owner/ Lessee/Agent Sikffffure of Contractor/License Holder
STATE OF FLORI i ,+ STATE OF FLORIDA r
COUNTY OF - f� �c COUNTY OF .oaf •fes -
The forgoing instru sent was acknowledged before me The forgoing instrument was acknowledged before me t
this day of 20 I Lby this I day of , 20 f by
(Name o erson acknowledging ) (Name of pe son acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Prod pe of Identification Pr
MIKE Mam
Commission Na. ry ( PUNIC - State of Flor mmission Na. � ' Not"?N" -11110 tiE Flo W
A'Nla mialon # FF 216951 : • _ CommIssIm # FF 248651
My Comm. Expires Apr 5, 20 9 �` My Comm. Expires Apr 6. 2019
IIIN qNl•
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS