HomeMy WebLinkAboutBuilding Permit Application 7�28�1U803 p2
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.S.QPPLEMENTAL CONSTRUdTiQ:N LIEN.LAW' INFC}WATION.
DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: _Nat Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: ____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 thepermit holder to build the subject structure
which is in conflict with any applicable Horne 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,wails,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 financi ,co ult wi n attorney before
commencing work or recording our Notice of Commerxement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF sr..uciE COUNTY OF sT LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgeq fore me
this_�day of �{� 20 f�by this'day of I°IY .20 _by
;� ! (� / o+;p'••�� Lori Diodato
vL)r5,.1 V .lei J r +y t /. Don J Miranda :°o U%11g'comm aION#EE 856794
(Na a of persona n ledgin } (� � {Marne of person acknowledging) ; '.,._ :EXPIRES:FEB.09,2017
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida}
Personally Known OR Produced Identification Personally Known XX« OR Produced Identification
Type of Identification Produced Type of Identification Produced
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w.��grn�e, it_Ori Diodato
Commission No. :rte �r W%IMEE856794 Commission No. (Seal)
DFIRES:FEB.09,2017
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Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS