HomeMy WebLinkAboutBroad AC Change out Permit pg 2 001 SUPPLEMENTALCOMMUCTION LIEN LAW INFORMATION:
UE—
Mar
ne:
Not Applicable
Da E ANY- trotAWlicabie
me: !Name:
Address: Address:
City State: City: State:
Zip_ Phone Zip: Phone:
FEE SIMPLE TITLE HOLDEtt. Not Apphcabte BONDING COMPANY. Not Applicable
Name: Name.
Address: Address-
City City-
Zip: Phone: -Tip: Phone,
OWNER/CONTRACrOR AFRDWr_Application is hey made to obtain a pern it to clothe wmk and installation as indicated.
i certify that no work or installation has commenced priorto the issuance of a permit
St.Lude2au tymakesnorepresentationthatisgrantingapermitwillauthori_ethepermit holdertobuildThesubjectstructure
which is Inc rt rctw with any applicable tkime Owners Ass n rules,bylaws orand nants that may restrict or prohibit such
sb"n"ure-Please
consult rwthyourHome Owners Association and review your deed for any restrictions . mayapply.
In consideration of the granting of this requested permit,1 do hereby agree that I will,in all respects,perform the work
in accordance with the approved plan-,-die Florida Building Crades and St_Lucie ConntyrAmendments.
The following building permit applications are exempt from undergoing a full concuerency review.room additions,
s
accessory structure swimming pocils fences,walk,signs,sceen rooms and accessary use;to another non-residential use
W TOOVMER:Yew failure to Record a Notike of may result in y paying NAM for
improvements to your property.A Notice offCommerrcerr ent must be recorded and posted on the jobsite
before the first inspection.if you intend to obtain finandbF,Consult with tender or an attorney before
commend work or recording your Notice of Commencement_
Slgnaiure of Owner/i;iz lCuntractor Agent fur r Signature of Contractor/license Kolder
STATE OF AUNTY Ff3RIflA IS[ rlgrn CCTA 1FFSAR$13 i �
W`UCr diL3E�'"Y€ €�F lttkl
The forgoing insburnentwasadinowledged before me The forgoing instrument was acknowledged before me
this f fAdayof_rnZW,% zuzo by this f3*,day of' zUyO by
Nam of persm/relcing sthement Name of per-solifnaldog statohnent
Personally Knmwn OR Reduced ide ntdicalmn personally Known OR Produced Identification
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Type of Identification Type of Identification r
Produced Produced 11
(Signature of Notary -State of Florida I (Signab"'ofNrdary "State ofRodda)
Commission IN `P�„ °.,. HRISTINE Comm (Seal)
J. CONJNELL „;,„
`l o: Notary Public-State of Florida -
_ U _ Co _c`i;�P CHRISTINf
REVIF`,NS �'<orF°moo`, Bon a mm.Expires qu - �, m rubllC-State Pori ;
�W ional o R- PLANS ors 833 i�ANGROVE
RE1fI E y KMEW
DATE onal Nei1 ss
RECEIVED
DATE ,
connPlFfl=n
Rev.8/2/17
Close with the I am Responsible Pledge and the Lord's Prave.r