HomeMy WebLinkAboutHalen AC CHange out permit app pg 2 001SUPPLEMENTALCONSTRUCTiON UEN LAW INFORMATION
DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY- _ Not Applicable
Address: I Address:
City. State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE I3LE HOLDER: Not Applicable — 80NDWG COMPANY: _Not Applicable
City: City
Zip: Phone: Zip:
UW NER4 CONTRACTOR AFFIOVIT: Application is hereby made to obtain a permit to do the work and installation as indicated -
I certify thatrro work or installation has commenced prior to the issuance of a permit
St Lucie County makes no representation that is granting a per;nie will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anrf 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 respells, perform the work
in accordance with the approved plans, the Florida Btrilding 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: Your failure to Record a Notice of Commencernent may resent in your paying twice for
improvements to your property_ A Notice of Commencement roust 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 nr rprnrdina vnnr Nntira of Cmmnrumnnt
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Signature of Owner( Lesseef ontractor iE Agent for caner
Signature of Contractor/license Holder
STATE OF FLORIDA I tIn nn
COUNTY
STATE OF FLORIDA
Jl
OFS. t M �l C
COUNTY OF c .
The forgoing instrument was acknowledged before me
The forgoing instrument w acknowledged before me
thisAwday Of i _ ,20a by
day of MIir 26j.�_ by
�t►chael F boy I�
Icl�It�¢t F I�
Name of person king atemerrt
Name of perso aking stat ent
Personally Known OR Produced identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur
(Signature of Notary Publ' fate of Florida)
Commis
CHRISTINE J. CONWELL
ac; Notary Public - State((8M)ida
'-'
Comm Or noa CHRISTINE J. CONW� e !
fission # GG 017839
3r� - o ary u - State of FForg
%+ My Comm. Expires Aug1, 202o
9
'• . •' Commission # GG 017839
. Bondedlhrcu h
%. or Mv omm. Ex Tres Au 21, 2020
'•u°,`„:•`dBonded th
ough National Notary As
n.
REVIEWS
FRONT
ZONING
SUPERVISOR
_
PLATYS
ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECENED
DATE
CONiPLETEII
Rev. 8/2/27