HomeMy WebLinkAboutwh appl. 12.17.2016.1SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State: _
Zip: Phone: Zip: Phone:
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. --- .
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Signature of Owner/Les ee/Contractor as Agent for Owner Signature of Contractor/Dense Holder
STATE OF FLORIDA
COUNTY OF
The fprLing instryrrtent wast ack_nowledgeq Pe ore me
this day of C&VA b . 20 Lb
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(Name of person acknowledgi )
gnature o No rNwublic- State of Florida )
Personally Known 1__�OR Produced Identification
Type of Identification Produced
STATE OF FLORIDA
COUNTY OF e
The forgoing instrument was ckn Wedged before me
this day of d:q�rrQA%t7 , 20 � by
(Name of p so ckno ledging )
ignature of otiKry P ic- State of Florida j
Personally Known !oma OR Produced Identification
Type of Identification Produced
Y MY COtvttvllSS10N # FF2"36 �Ission No. --� — —
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os EXPIRES May 21, 20113 EXPIRES
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS