HomeMy WebLinkAboutLaBeau AC Change out permit app pg 2 001SUPPLEMENTAL CONSTRUCTM UEN LAW INFOR TION-
DESIGNERIFENGINElI
Nance:
_ Not Applicable
M E COMPANY-
dame:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State: _
City:
zip: Phone:
State:
FEE SEND WFILE
Dame:
Not Applicable
BONDING COMPANY:
Name:
—NW.Applicable
Address:
Address:
City:
City.
Zip: Phone:
Zip: Phone:
OWNER/ € FOR oaf VlS: Application is hereby made to obtain a permitto do the work and installation as indicated_
l certify that no work or insta€€abon has commenced Poor to the issuance of a Permit
structure Please consult Ufa your ;come Owners Associaticin and review your deed for any restnc'titons wnscn nay apply.
In consideration of the grantim of this requested permit, I do hereby agree that i will, in all respects, perform the work
In accordance with the approved {clans, the Florida thrilling Codes and St. €.ude county Amendments.
The following building pertnat applications are exempt €ram undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen moms and accessory uses to another non-residential use
WARNING TO a Yew fMore to Record a Notice of Corara encement may result in your paying tyke 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
cornmencine work or recordim vour Notice of Commencement_
kJ��
Signatura al 6wri er Lessee/Contractor Agent far vvne€
Signature o€£anuactarlUcense Holder
1
STAVE OF FLORIDA Gy f , , n
COUNTY tilt
STATE OF FLf33'siDd c
COUP OF St- Luck.,
3
a
The rg ktstruraentwn acknowledged before me
this�dayo€,�•�Saa M6-r by
The forgoing instrument was admowledged before me
thlts�ayof SitDfP bAr i 2iE}��Zo by
i,2020
l�t�t -F
��
lCYlLi.�l F i&
Name of tement
Dame of perso aking statalment
Personally Known OR Produced identification
Personally Known OR Produced identification
Type of identification
Type of identification
Produced
Produced
, �(f',;,� p
{Signature of Notary ic- state of Roridal€S'�nati
a of iia ary s� c- Smote of Harsda ,
Commission No. ;'iirv'F� -..,., ota P1NF,t0YLE a of Flo L
otary Pu to of Flonda
Commission X GG 984707
'gr My Camm. Expires Auq 21, 2024
tonal Nota 4ssn.My
�Y on^-.CHRISTtNE JOYCE C j
l
commtssiostfillip
Notary Public - State o Fion a
Commission d GG 984701
Comm. Expires Us 21, 2024
on eouln
National Notary
sm.
j
REVIEWS � Fiii} € ZONING SUPEliV60R
� PLANS
'4 t
MANGROVE
..A TURTLE
f
COUNTER REVI-cW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8I2{17