HomeMy WebLinkAboutWyant AC Change out Permit App pg 2 001SUPPLEMENTAL CONSTRUCfiON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER. Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: —
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER( CONTRACTOR AFFIDVIF: 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.
St. Lucie Coupty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cordlict with any applicable Rome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Rome 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 mncurrency, review: room additions,
accessary structures, swimming pools, fences, walls, signs, screen roams and accessory it es to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice far
improvements to your property. A Notice of Commencement mast 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.
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Signature of Owner/ Lesseej£ontra or agent for wrier
Signature of Contractor/License Holde
STATE OF FLORIDA Gi
COUNTY OF
STATE OF FLORIDA
a. LuCiC,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgaing instrument was acknowledged before me
this -L:SLI-dayoffgrlLl[Ura 20 by
this _day of .20� by
Name of person/flaking s tement
Name of perso along star ment
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
pp
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{Signs a PubIWFBt Eof "09W RI
ISignato a ar a
Notary Public - State of Florida
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Commi Q •e Commission # GG 01`-@0
;ra�µ1 P�s�, CHRISTINE J. CONW tt
°• Notar EE
Comm E y Public
- State of (4mlgl
My Comm. Expires Aug 21. 2026
yZ ommission # GG 017839
Bonded through National Notary Assn.
My Comm. Expires Aug 21,
,,,n•,.•• Bon 2020
ASS
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REVIEWS
FRONT
ZONING
SUPERVWR
PLANS
VEGETATION
SEATURTL_
ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17