HomeMy WebLinkAboutPerry AC Change out permit app pg 2 001i
SUPPLEMEWAL COMMUCTION LIEN LAW WO
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7xau axwatc uwceCislillY4idtgtYt drEi2 reyre yCrFirvee{r 7iFFsiT{y €e5ti7CililAS.uhS€r'! may apply.
In consideration of the granf%of this requested perrnft, l do hereby agreethat l will, in all respects, Perform the work
in accordance with the aged plans,the Florida & mg Codes and St Lude Cormty Amendments
The foltowft building Permit applications are exempt from undergoing a full conrnrrency review: room additions,
accessory structures, swimming pools, fences, walls, s screen moms and accessory use to another non-residential use
WARNING TO OWNER: your famure to €teciarda Notice of Comatencernem may result inywrpayi€Igtvdm for
irnprovernents to your property. A Notice of Commencement crust be recorded and pasted on the jobsite
before the first inspection_ if you intend to obtain financing, consult with lender or an attorney before
ctrmtnencing work or recording your Notice of Cornrnencement
Skgnai[ve of Contractor/License Holder
Signature or O ner/ i esseQ oniractor'� Agent for caner
TATE FLORIDA I
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Nam€FLORIDACOUNW, Lad
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The forgoing instrument was aclmowiedged before me
The forgoing i ment was acknowledged before me
ihis�day of,j(j l .20'ZO by
thisday of 2029 by .
Mic to
Name of persarVilaldrig stkement
Name of persa ' statilment
Personally Knorm OR Produced Identification
Personally ]Chown OR Produced Identification
ication
Type of klertificatioh
Type of Identification
Produced
Produced
n �
(Signature of
0f F[orioia }
ott°r HRISTINE J, CONWELL
Commission _ : Notary Public '{}of Florida
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_ '20°' CHRISTI s
mission # GG 017839
, . � My Comm. Expires Aug 21, 2020
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SUPERVISOR
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REVlIEW
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REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev_ BM17