HomeMy WebLinkAboutRichardson AC Change out permit app pg 2 001r
S€iPPL.E E `€ L CONSTRUCTION UEN LAWINFORMATION:
DESiGNERJENGINEER: _Not Applicable MORTCAGE AAIy: — A }E able
Name: flame:
Address: Address:
State: City: State:
Zip: Phone Zap: Phone:
FEE SIlyB U TITLE HOLDER:DER: i Not Applicable BONDING €VIPANy— Blot Appl€cable
Name: Name:
Address: Address:
City: City:
Zip: Phflne: .Tsar: Phone:
CONTRACrOP.AFFIl :Application is hereby made 7n obtain a permitto do the work and installation as Indicated-
i certify that no work or installation has comintrwreced prior to the issuance of a permit
St[side Coun makes no representation thatisgrantingal ,alifauthorizethep holder to build thesululectstructure
which¢in conflict with any applicable Home Owners Association rules,bylaws orand co .anY$€teat may restrict or prohibit such
structure.Please cormultwrth your Name Owners Association and review your deed for any resuictions whIch may apply.
In consideration of the granting of this requested permit-.,i do hereby agree that I dull,in all respects,perform the work
in accordance with the approved platy;the Ronda wing Codes and St Lucia County Amendments.
The following building permit applications are exempt from undergoing a full omicurrency review:room additions,
accessory sttuchures,swimrrting pouts,fences,walls,signs,screen rooms and accessory uses to another nonresidential use
WARNING TO OWNEIh YrAw faHure to Record a Notice of✓Lornrrierroemem may result in your paying tinke 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 lender or an attorney before
commencft work or recording Notice of Commencement
SignatureofOamerlfessee/Lontrarmr' Agent 0yearner Signature ofComattor/LicenseHolder
STATE E(3F FLORIDA �F e, tE OF]FLORIDA
COUNTY OF uru
The fo ng _ merftwas acknowledged before me The tonoing instru ent was acknowledged before me
this day of 20 20 by this Oy day of 2#l2au by
(Michael F a lze Wc�21 F Ri le '
Name of personAtakingstitement Name of alarg statement
Personally Known OR Procktoad Identification Personally Known OR Produced Identification
Type of identification Type of identification
Produced Produced
(Signature of Notary Gc-state of Honda) (Signatureof Notary P tc•state of Florlda)
Commission •,•�`r'dr ko, CHRISTINELL
ty, -St�lof FloridaCommis '�'�"�CMRI TINE J.C WELL
o ary Public-State of Flo ••�"` °pa''-
•` Commission#GG 077639 =•'o `�= Notary Public-State of Florida
AromUpkal; Commissi n
"'t����""• Bon dthrou h t '•7,'For F`oe°-° MY omen.Expires Aug 21 2020
g National
REVIEWS r R P}.ANS fond �94AfEilbllbotar GROVE
COUNTER REVIEW REVIEW REVIEW tEW
DATE
RECEIVED
DATE
COMPLETED
Rev.812117
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