HomeMy WebLinkAboutLudwig AC Change out Permit pg 2 001I SUPPLEMENTAL CONSTRUCTION LIEN LAw i;4 FoRmATlow
asc,raarv�rca•cracatrvccas: _ NOI Rppnk' oke MORTGAGE COMPANY- Not Applicable
Name: Name:
Address: Address:
City- State: _ city: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: s Not Applicable
Address:
City:
Zip: Phone:
Address:
Zip:
_Not Applicable
OWNER/ CONTRACTOR AFROVIT: Application is hereby made to obtain a pemtit 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 Lurie Caunmakes no representation that is granting a per°nit will authorize the permit holder to build the subject structure
which is in co 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 rooms and accessory uses to another nonresidential use
WARNING TO OWNER, Your failure to Record a Notice of Commencement may result in your paying Ittarice for
improvements to your property. A Notice of Commencement must be recorded and posted on the iobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor 6Agent far caner
Signature of Contractor/License Holder
SATE OF FLORIDA
STATE OF FLORIDA ''I, ``
COUNTY OF IIA6 /
COUNTYOF a,W46
The forgoing instrument was acknowledged before me
The fa oing instru ent was acknowledged before me
A
this �f' day of 2020 by
this day of 2010 by
I�G�lGI2y
MtC4Ou11 Y j�
Name of person king st tement
Name of persopAnnaking star ment
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produc/e�Id
Produced
&- � Q®
(Signature of Not4hubffc, State of Florida)
{Signature of Public- State of Florida )
Commission J. �N ELL
COmmi55iQ a !)
,,,,,••--Cpp1STINE
Notary Public - State of Elorida
,.ti;pr'J••.,, CHRISTINE J. CONWELL
• ` Commission # GG 017839
%�; Notary Public -State of Florid,
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BATE
RECEIVED
DATE
COMPLETED
Rev.$/2/I7