HomeMy WebLinkAboutPERMIT APP 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Nat Applicable
Name:_ MORTGAGE COMPANY: Not Applicable
Address: Name:
City: Address:
State: City: Zip: Phone y" State:
Zip: _________ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — Not Applicable
Address: Name:
City: Address:
Zip: -Phone: City:
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 r
ooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must b ded in the public records of St.
Lucie Cou rid'ppsted on the jobsite before the first inspe . If you inten p obtain financing, consult
with I der or an otorne before commencingwork or re rding your Notice of Commencement.
r s''
re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF stUd.
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Don J Miranda
Name of person making statement.
Personally Known X__ OR Produced Identification
Pr
p eldentification°PBG��. Lori Diadata
--- Commission # GG069258
Expires: Feb. 9, 2021
Signature of Notary Public -
Commission No. FF945187 (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Stud.
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Don J Miranda
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification
Produce' :•�S*��•�tl�.,,e LOft t0 Q�
=�= Commission # GG4i
Expires: Feb. 9,
:r1M. OF � Bonded thru Aaron I
(Signature of Notary Public- State of Florida )
Commission No. FF945187 (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW