HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DEWGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
MANGROVE
Address:
Address -
State: City:
State:
City:
Zip: Phone:
Zip: Phone:
REVIEW
FEE SIMPLE TITLEHOLDER:
___. Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name.
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit
St. Lucie Counter 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 vour Notice of Commencement.
s
LAIlinature of Owner/ Lessee/Agent Sig re of Contractor/License Holder
STAVE OF FLORISTATE OF FLORID
COUNTY OF 4� ' '� ICOUNTYOF .��
The forgoing instrument was ac owledged before me
this day of �-9� 20 l � by
/11 P
(Name o person acknowledging)
The forgoing instrument was a knowledged before me
this-! day of L-- .20 L(L-1 by
(Name of rerson acknowledging)
(Signature of Notary Public- State of Florida j (Signature of Notary Public- State of Florida )
Personally Known V1 OR Produced Identification Personally Known i� OR Produced Identification
Type of Identification Type of Identification Produ
#MILE MARTIN pills,
4 i,,:,-_ MARTIN
Commission No. Nosirroa Me . slam oI Fbft Commission No. (Seal) Public - state of FW
Commission # FF 216951 •' Commission x FF216951
Revised 07
Bonded through National Notary AM
REVIEWS
FRONT
ZONING
SUPERVISOR
PIANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS