HomeMy WebLinkAboutBuilding Permit Application 772871087728710863 p2
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Miranda Plumbing&AC 7728710863 p•3
SUPPLEMENTALC. NSTRUCTION LIEN'LAIN.:'INFORMATIC}N: :
DESIGNER/ENGINEER ^Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: i Address:
City: ! State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOWER: Not Applicable BONDING COMPANY: "Not Applicable
Name: Name:
Address: Address:
City: ? City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTO!,R AFFIDVIT: Application Is hereby made to obtain a permit to do the work and installatlon as indicated.
I certify th at 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 an} appilcabie Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w1th 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.Lucle County Amendments.
The following building pe i it applications are exempt from undergoing a fui;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 a first inspection. If you intend to obtain financing,consult with lender or an attorney before
corprilenbing work or recording our Notice of Commenceme �.
signature of Owner/Agent/Lessee signs re_df C ntrA aactor/License Holder �l
STATE OF FLO STATE OF FLO E
COUNTY OF I I COUNTY OF.? [ �'i
The forgoing Inst ment.was acknowledged before megol'..... The forgping instrumen was a knowledged before me
this�llay of Z> 26Laby = this)YU day of 1 n; 200by
60
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1t! �.! ! / !/ r++, Aa f �."I rllcCl^rs,at
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(Name96 son acknowledging) m a_ {Name pfpersan acknowledging} y a rn
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SigKature of N' ary Pubiit-lta a of Florida) 8 c v {Signature of Notary Public-S ate of Florida) n cr
ra re
Personally Known-!-I,OR Produced Identification Personally Known �R Produced Identification
Type of Identificatiorged__ Type of Identification Produced
Commission No.UL362b 3 S� (Seal) Commission No. -C •a� (Sear)
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Revised 07,'1512014 i
REVIEWS FRONT} ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE I
COMPLETED
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