HomeMy WebLinkAboutMyers AC Change out Permit App pg 2 001SUPPLEMENTAL CDNSTRUC iON LIEN LAW INFORMATION:
DESIGNER/ENGINEER— —Not Applicable MORTGAGE COMPANY: _ Not Applicable
Address: I Address:
City: State: I City: State:
Zip: Phone Zip: Phone:
Address:
City:
Zip: Phone:
SONDING COMPANY. _Not Applicable
Address'
City:
Zip: Phone:
UWNLV4 i(3NTRACTOR FiDVIT: Application is hereby suede to obtain a permit to do the work and Enstatfation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
EZ
In consideration of the granting of this requested permit. I do hereby agree that I MR, in all respects, perform the work
in accordance with the approved plans, the Florida ankling Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory use 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 tender or an attorney before
commencing work or recording your Notice of Commencement -
Signature of Owner/ LesseejCo ctoi _tint f Owner
Signature of Contractor/License iiof r
STATE OF FLORIDA
COUNTY OF
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FLORIDA 5L.
Lul.
CO NW O 1
The forgoing insrumentwas acknowledged before me
The forgoing htstrument was acknowledged before me
this J 1. r day of MraA4,
20AI by
this f day of Mn, 20-L by
Ro
Name of pew>a4zing
statelinent
Name of perso5z6king statehient
Personally Known
OR Produced identification
Personally Known Ill OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
-
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(Signature of Notary
- State ofFlorida j
(sigrratur o`4Nx -ONWE
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Commissi a ••..
CHRIS NE J. C
zl�'q Notary Public • State oPANI?
COMM'i5l d in a GG 0
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Notary Public - State of Flol
My Comm. Expires Aug 21, 2020
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Commissfon M GG ot7839
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S ERVISOR
' PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVI
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev_$/2/17