HomeMy WebLinkAboutSignature Page Jan 11 1711:15a Jack Frost A/C of So Fla 772-336-9032 p.1
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SUPPLEMENTAL 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 StMPLETITLE HOLDER: Not Applicable BONDING COMPANY: Y 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 Coun�y makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflictwith 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 roomsand 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 jobsjte
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
QLJ'V�- ,srafrAnt—
Signature of Owner/Lessee/Cont for as Agent for Owner Sign Luctor is se Holder
STATE OF FLORIDDA�, // STATE OF FLORIDA �v�
COUNTY OF of /.�CC!t a COUNTY OF X3-1 .
The forgging instru ent was acknowledged before me The forgging instru ent was acknowledged before me
this 1!tAay of a►7 t c! . 20 L'/—by this�VL--`d.ay of 20 ZI by
7(Nameperson acknowledgin (Nam/of. erson acknowle ing
A/1411
gnature of Notary Public-State of Florida j ( ' ature of Notary Public-State of Florida y
Personally Known OR Produced Identification I/ Personally Known OR Produced Identification
Type of Identification Produces 0_141:%= ,'10—`'111&—b Type of Identification Produced
Commission No.!✓F60713SaRRISTINA R.PARS tWmmission No.F��793� (Seal)
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NOTARYPUBLIC KRISTINA R.PARSCM
NOTARY PUBLIC
~Comm#FF007935 STATE OFPi_ORIUA
Revised 07/15/2014 F �' Expires 4123/2097m Comm#FF007935
9� ExDires 4/23/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS