Loading...
HomeMy WebLinkAboutWhitlock AC Change out Permit App pg 2 001SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER%E%GiNEER: _ Not Applicable Name: MORTGAGE ANY- _ Not,Applicable Blame: Address: Address: City: State: Tip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name-. BONDiING COMPANY. _Riot Applicable Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR VIT- Applimtr n 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. Sf_ Lude Coun makes no representation that is granting a Permit" t authorize theme permit holderto build the subject structure which is in cost with any applicable Nome Owners Association rules, bylaws or and covenants that may, restrict or prohibit such structure. Please consult with your Nome Owners Association and review your deed for any restrictionswhich may apply. In consideration of the granting of this requested Permit, t do hereby agree that t will, in all respects, perform the work in accordance with the approved plans, the Florda Building Cow and St. Lude County Amendment& The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screens rooms and accessory uses to another non-residential use WARNING TO OWNER: Yaw failure to Record a NoUce a Commencement areal€ result in your paying mice 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 financing, consult with lender or an attorney before N STATE OF FLORIDA COUNTY OF J 1. LucQ The forgoing in Intent was acknowledged before me this j(�day of 2©J4 by Name of persoking statement Personally Known v OR Produced Identification Type of Identification Produced (Signature of P Commission lot S REVIEWS DATE RECEIVED DATE COMPLETED Rev.8/2/17 Public- State of Florida ) CHRISTINE J.(M?YELL otary Public - State of Florida Commission 8 GG 017139 COUNTER I REVIEW I REVIEW Signature of ContractorjLicense Hold - STATE OF s ' ► "- s The forgoing insVu ent acknowledged before me this j day of Mn _ 20l� by IVI,Ii(hd.f F 'Boy( Name of person king statement Personally Known V OR Produced Identification Type of Identification (Signature of Nat iy Sta47 �'�)•` Notary PublicFc „ ug 017 _ '�'-i Bontletl throughXNaroPires Atl9�12020 JIVY.ASsn. PLANS VEGETATION SrA TLfRTLE RO RFViEW REVIEW REVIEW I REVIEW