HomeMy WebLinkAboutWood AC Change out Permit App pg 2 001SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name.
BONDING COMPANY: _Not Applicable
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 -
t 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 permitholderto 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, l do hereby agree that I will, in all respects, Perform the work
in accordance with the approved plans, the Florida Building Codes and SL Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimnung 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor canto wner
Signature Contractor/License H61der
of
STATE OF FLORIDA�L j
COUNTYOF l—UCIQ_�'
STATE OF FLORIDA
5b. Lm&
X31.
COUNTYOF
The forgoing instnrmentwas acknowledged before me
The Forgoing i meat was acknowledged before me
u(�,1�_
this l � day of �Q.lili , 2011 by
this day (if 20tq by
Michael �r &Vie,
wicw( F 60 [el-
Name of person ria statement
Name of perso aking st tement
Personally Known 10 ]R produced Identification
Personally Known OR Produced Identification
Type of identification
Type of identification
Produced
Produced
Q�
{Signatu p , : 'N013ry u tate %rida
(Signature
-S tp of torida )
is - o
. •_= Commission # GG
Comms • e
`
Commissi
r14ECHRISTINE J. C01J,¢VEl1,
" 'e(y dl
lic - Stat itla
+ ices Aug 21. 2020
Bonded lhrougn National Notary Assn.
Commission # GG 017839
'4y Comm. Expires Aug 21, 2020d.`
u Nationaloar
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
GROVE
VEGETATION
t i
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17