HomeMy WebLinkAboutBrodeur AC Change out Permit App pg 2 001SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DES KaEUERjEfi1GINEE€ .- _ Not Applicable I MORTGAGE COMPANY: Not Applicable
Name: Name:
City:
Zip: _
Phone
State:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. _ Not Applicable SOIVQING EOMPAfdY: _Not Applicable
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
r,ravtatttf iUty t KAIL#UK A% Y-10Vi F: Application 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
St. Lucie County makes no representation that is granting a permit will authorize the permit holderto build the subject structure
which is in conflict with any applicable Home 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, walls, signs, screen moms and accessory uses to another non-residential use
WARNING TO OWNER: Your fails re to Record a Notice of £crornmencernent 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 vnrir Nnticp of rnmmpnromant
Signature of Owner/ Lessee/Con o Agent Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF St. �d
STATE OF FLORIDA f
CejP
COUNTY OF L l t�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2L5 day of SUVIQ' 20OL by
this 2Lday of ; JIA VIQ . 20 I�' by
�iic�aP( Bide
Wklpf '- o�
Name of person mg state ent
Name of person aking statement(
Personally Known - OOR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of identification
Produced
Produced
(Signature
i ubtc-StateofFioridaj.TA1,n
(Signatu
Nta P '-
Commissio
e°. Notary t .r
t , .(Sea
icon •
Commissi
,o•�r'•••••, CHRISTINE J. CONWELL
`a<'"•; otar Pu01ic-Stale e(�a
M Comm Expires Ai.,
`• ' Commission ar GG 017839
Bondeo through National Not
' ,ES` My Comm. Expires Aug 21, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
MANGROVE
VTGPATION
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/27