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HomeMy WebLinkAboutSIGNATURE PAGESUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGN ER/ENG INEER: Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: BONDING COMPANY: Not Applicable Name: 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 l will, in all respects, perforin 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 worj�..,recording your Notice of Commencement. 0-/ 1 s -- Signature of Owner/ ssee/Contractor as Agent for Owner - - +i Signature of Contract—or/Li.c6nse Halder STATE OF FLORIDA JJ_] ; STATE OF FLORIDA ' ��'t "L COUNTY OF t COUNTY OF The forgoing instrume t was acknowledges! before me The for oing instrument as acknowledged before me Q � (6 this N day of ?{' 9 2© J. by11 this day of . 20 by u r l � i! � Y 9 d �� V L �J•-I{{-9`x/7 Y L'v d/ (Name erson ackn wledgi 4 (Name of p on a nowledging ) I % ig ature o No ublicc-- State of Florida) I I, ('nature of Notary b of Florida ) �Staate Personally Known OR Produced Identification Personally Known G✓ OR Produced Identification Type of Identification Produced Type of Identification Produced T Commission No. (Sear Commission No. JE:m w,k!AI41 ItAyR�t�FI� EIt gdifi6 iM JOWApiHAN RAYMONDFiiZPATFf%K MY COi4 MIrS$ION fi FF233882 MY COMtMISSlC?N # Fi`233682 •-',''o, •,.• EXPIRES Way 2f, 2019 Revised 07/15/2014 EXPIRES May 21,2019 ,�vnat.es ss FkVXUN0W'ySa-vic,..cc® 401) Sem bS FlordalloarySevlcacum REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW - COMPLETE INITIALS