HomeMy WebLinkAboutMartin AC Change Out App pg 2 001SUPPLEMENTAL CONSTRUICTION 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 AFFIOVIT: 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 aerm€t holder to build
such
nuuu re. rrease consuic vriur y€ w mme corners Association aim review your uem Tor any resmcoons wmcn may appty.
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: 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 fender or an attorney before
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Signature of Owner/ Lessee/Contractor Agent far er
Signature of Contractor/License Holder
STATE OF FLORIDA JI . I.I j Q. I COUNTY OF FLORIDASTATE OF JI . ' n &
COUNTY OF JI JI LtAla
The forgoing instnrme t as acknowledged before me
this �day of Dr.�'or1 20 IA by
Wchal,t F Boy le,
Name of person king stitement
Personalty Known OR Produced Identification
Type of Identification
Produced
(Signature of
COMPLETED
Kev. is/tile
State of Florida)
CLF:. ($Fat41]:LL'
Dtary F.�: r_ 5'1ate of Flgrida
Commiss,nn a GG 017839
COUNTER I REVIEW I REVIEW
The forgoing -instrument was acknowledged before me
this i'r- day of C) �lJ2� 20 1f by
a
Name of persopinaking statdment
Personally Known �r OR Produced Identification
Type of Identification
e -nnrbr7NEJ. CO
Notary Public - StateNWEL)da
"olmfssion # GG 017839
A ➢Comm. Expires Aug 21, 2020
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