HomeMy WebLinkAboutLloyd Permit for AC pg 2 001SUPPLEMENTAL CONSTRllCT!ON UEN LAW INFORMATION:
DESIGNERANGINEER: 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 AFFIDVTT: 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
the permit holder to build the subject structure
and covenants that may restrict or prohibit such
red 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 rooms and accessory uses to another non-residential use
WARNING TO OWNER: Yrner lure 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 on oe Agent for wrier Signature of contractor/License HISIder
STATE OF FLORIDA C�
COUNTY OF �I I UL
The forgoing instrument was acknowledged before me
this f5Lk day of dit t (A.— 201 I by
W1100 F Boy (ems
Name of person aking stfitement
Personally Known OR Produced Identification
Type of identification
Produced
CHRISTINE J. CON
-Nutao-y PuBFie-• State II"da
Commission # GG 017839s
My Comm. Expires Aug 21, 2020
COUNTER t REVIEW t REVIEW
RECEIVED
Rev.
STATE OF FLORIDA
COUNTY OF S�• L"6C."
The for ing instrument was acknowledged before me
this I'S day of �U l� 20 (A by
M(14 fed C & Ie,
Name of persopofmaldnig statement
Personally Known V OR Produced Identification
Type of identification
Produced
�Rec
UNN16 FINE J. CONWELL
Notary Public - State of III
oC mmission # GG 017839
My Comm. Expires Aug 21. 2020
PLANS REVIEW I REVIEW EGETATION i REVIEW E REVIEW