HomeMy WebLinkAbout10.13.2016 - Permit Application for Duraseal of the Treasure Coast (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
dame:
Ad d ress:
Ad d ress:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY. Not Applicable
Name:
Address:
City:
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: roomadditions,
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 osted on the jobsite
before the first inspection. If you intend to obtain financi suit with lend e ora orney before
commencing work or recording vour Notice of Comme ement. ,
Signature of Owner
t for Owner I Signature of Contractor/Licenle Holder
STATE OF FLORID r� STATE OF FLORIDA
COUNTY OF Luf LG COUNTY OF V"(Aa,kn
The forgoing instrument was acknowledged before me The forgoing Instrument was aeknowledged`before me
this2]Q,day of `nV1^he� 20 /by this Z(�P day of20 by
(Name of person acknowledging.) (Name of person acknowledging)
(Signature of Nota ublic- State, of Florida) (Signature d Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced:tA24.1Z swtdx3 Type of Identification Produced Mois bah
fmi:i #�O NOTARY PUBLK
Commission No. 6��
Qw01 %U j-Lylgr Commission No. �� � STATE OF FLOP
OI-)TIj)d A8,41ON Coma* FF95636
- --......, 1. .. , - .
Revised 07/15/2014
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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