HomeMy WebLinkAboutSIGNATURE PAGESUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: 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:
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, consult with lender or an attorney before
commencing work-ar wording your Notice of Commencement.
Signature of Owner
as Agent for Owner I Signature
rise Holder
STATE OF FLORIDA 111 1
STATE OF FLOR16A �`�
COUNTY OF G COUNTY OF _3 luc4k
The f oing instrument wasacknowledge efore me The forgoing instr ent�w�as a knowledged fore me
this day of4/�20 by this � day of �L`(' 20 by
r � .
(Name of Orson ackno ledging) (Name of perscp acknowledging )
sgnature of Not r l7lic- State of Florida) (Signature of Notary Public ate of Florida )
Personally Known L// OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
(Seal)
Commission No.
y►R`ry-'I JOHhAiHANRAYMOND FITZPATRICK
;;p• �"4 =
JOHN A7HAN RAYMOND FITZPATRICK
:"'
=•: MY COMMISSION # FF233682
MY COMMISSION # FF23368�
w EXPIRES May 21. 2019
Revised 07/15/2
1,.. •
EXPIRES May 21.2019
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