HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: 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. 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, cons* with lender or an attorney before
commenQ4v%work or recording your Notice of Commencemer1!/
Agent
SigNa�Ir ire of contractor/Licelnse Holder
STATE OF FLORID STATE OF FLORI
COUNTY OF CG COUNTY OF ,AV7 �i 1, C o u w
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of , 20 _by this day of , 20 by
C Y1 C,'t% g n!y b Ae ti C r0, G Y i O h 1,4- q
(Name of person acknowledging) I(Name of pers acknowledging )
n JL
440
(Signature ofolotary Public- State of Florida) I (ignatur f Notary Public- State of FiOrricla )
Personally Known )0 OR Produced Identification
Type of Identification Produced MARY ANN nauI
NOTARY PUBLIC
Commission No. E fr'93,51-1 STATE OF FLORII
Comm# EE883581
Revised 07/15/2014
Personally Known )L:7 OR OR Produced Identification
Type of Identification Produc MARY ANN OAKLEY
r TARY UBL"
Commission No. t F STf FLORIDA
. Cmhm# E83b
881
Expires 3/13/2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS