HomeMy WebLinkAboutDavid Jones AC Change out permit app pg 2SUPPl..fMENTAl CONSTRUCTIONUEN tAW INFORMATION:
DESIGN INEER: -Not Applicable MORT6A6E COMPANY: _Not Applicable Name:. ___ .. ____________ _
Address: -----------------City: ____ -_____ State: __
Zip: _____ Phone.__ __ ....;.. _____ _
Name: Address.__: ______________ _
City: __________ ___,State: __
Zip: _____ Phone:. __________ _
FEE SIMPIE Tnl.E HOlDER: _ Not Applicable BONPINGCOMPANY: _ Not Appllcable
Name:. _______________ _ Name:.__ _______________ _
Address:
.__ _____________ _ Address: _______________ _
City:. ______________ _
Zip: _____ Phone:.__ ______ --c __
City: _______________ _
Zip: _____ Phone:.__ _________ _
OWNER/ CX>N1RACIOR AFFIDVIT: Applicaliou Is herelJy made1D obtain a permittodothewark and installation as indicated.
I certify that no work or -⇒r ·••• h&> UldiiiieiiU!d prior1D the iss<a«.e of a permit.
.St.lucie~rb:s11u1ep:ca.tationtflatbgia11i1,g"~wHlaulholizetbe~holdertobuildthe~structure
which Is in with=•• aNe Home Owner.; As St◄ • ~ bylaws or ClM!llaRts that ma, n!5lrict or prphibit such
structure.. Pleasemnsult~-'°"'"a Home OWnersAsw ia3iw and review you.-deed illl\' U!StJittions .hidl may apply.
1n C011Sideralion oftbeg,anlh1g oflhls '""Pies!Pd permit.: do be,eby agree that I will. in al •upem. perform thewori:
iu acconlauee 1'lilh theapprtM!d plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt flOm undagaioig .. full aincurrency mview: room additions,
aa:essory structures. swimmil,g pool!.. fences, walls, sign!;, 5a1!e1I rooms anti accessory 'IISl!S 1D another IIOIHZidential use
WARNING TO OWNER: Your failure to Record a Naticeof Couunancement may result in~ paying twice for
improvements to your property.A Notice of Commem:ement must be rea>tded and posted on the jobsite
before the first inspection. If you intend tn obtain financing, c:onsult with lender or an attorney before
commenrin"wortc orrecordi Notice of Commencement.
SfATE Of FLORIDA t:,J.. Lu.el COUNTYOF ___ ~'-'~'•~_l __ _
The fotgoil,g lnstrumentwasadmowledged belore me
this .ffi: day of f &I/P;9" . 20;tf by
~F.~
Name of~ Hf!dt
Personally Known _j/,__ OR Produ<ied kludificaliln> __
Type of 3dentilicatlan Produced.__ _______ _
Cl,,,k -J· fln,,,,a_
(Signature of Notary State of Rorida )
Commlssioll No. _,. _,..,. ,,,,, .._ CHRISTINE"JU'i'CE CONWELL
1 (ff';Jfii\ N,,.ry Public • s .. tuf Florld1
'· i Commission I GG 98<701
1------...---'lt-'\ / .. -...... ~ ........
""· '""so dtd thr0<J1h Nation I Notary Assn.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
.
COUNTER REVIEW REVIEW
Signature of Conlractorflice Holder
~~DA Jt-.Llcie,,
Thefotgoing ~ was admawledged before me
this_o!::_dayofyip/'114.(" .20..11. by
M,~ f. ~11€,... Nameof rifi1a1<mg=,e11t
Per.;onal3y Known OR Produa!d 1deulffitaliun
1ype of 3dentilitation
Produced~---------
{Signature of~ PJII' lC-StateofRorida l
~ -
PLANS VE6ETATION SEA 1tJlm.E MANGROVE
REVIEW REVIEW REVIEW REVIEW
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