HomeMy WebLinkAboutBuilding Permit Application (2) 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 SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: lNot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO ER OR AN ATTORNEY BEFORE RECORDING OTICE OF ENCEMENT:"
F
Signa ure o Owner/Lessee/Contractor as Agent for Owner Sign ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFstLucie COUNTY OF St Lucie
The f;Qrpy ing instru~�ent was cknowledged before me The forgoing inst Pn+�^is acknowledged before me
this day c` - 20 ! by thisf day of � p by
Don Miranda Don Miranda
Name of person making statement. Name of person making statement.
Personally Known xxx OR Produced Identification Personally Known xxx OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Signature of Notary Public-State Florida) (Signature of Notary Public-St � bra) Lod Diotiato
�iV,�'�/' Loft Diodato - CotnfilS$lon#GG469
' � S
Commission No. r�Sett' lrimiSSion#GG0692 kommission No. �1t1reS: Feb. 6, �
Expires: Feb. 9, 2 o� Bonded thru Aaron No
t4hru Aar
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.