HomeMy WebLinkAboutWilliams and Chitwood AC Change out permit app pg 2.pdfSUPPLEMENTAL COHSTRUCTION LIEN IAW INFORMATION:
DESl6NEI/EN6INE _ Not Applicable MOR1GAGE COMPANY: _Not.Applicable
Name: Name:
Address: Address:
City: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPlE Tl1lE HOlD£R: ~ Not Applicable BONDING COMPANY: _Not Applicable
1'Name: Name:
Address: Address:
City: City;
Zip: Phone: Zip: Phone:
OWNER/ <DNTRACroR AFRDVIT: Appli alil"' is hereby made1n obtain a penm:u, dotllewortcar>d ~ "5 inlftcated.
I certify that no work or ii>SlaHalicn, has rmrm.aw.ed prior to the issuance of-a permit.
st-1.ucie County mal<es , ... iqli lltalimt thatbgldUtiuga 1J<!Qllitwlll authorizethepermitholder1n build the~-
• which is in conllict with !'l'Y. '!11'1,&rahfe Home OWiiers ~ rules, bylaws or and aNeldnls that may: restrict or Pf!)llibit sud!
structure. Please amsuitwidi your Home OwnersAssociation and review your deed for aD\'leSbictiuus which may apply.
In cunsideratiun oftllegliiiotilCIJfthis requested permit, I doherebf agreethatl will, in al •es,e ls, pafutm the work
in aaonlance with the appnM1d plans. the Rurida IIUilding Codes and St. Lucie Cuonty Amendn,ents.
Thefulluwing building permit applications are exempt from undergoing a full CU11CU1,a1Cy ,-eview:. room additions,
aa:essmy ~ swiu ■ning jJUUls, fences. walls, signs, screen rooms and ill• esscw y d5l!5 tu another nlllW1!!5identi use
WARNING TO OWNB: Yourfailun! to ReaJni a Nolia! af Cammename11t may resultinyaar paying twice fur
improvements to your property. A Notice of Commem:ement must be recorded and posted on the jobslte
before the fif5t inspection. If you Intend b:> obtain iinancing, consult with lender or an attorney before
· wort or · Notice of Commencement.
~~,.£t£~tmj,mer
STATE Of FU>RIDA ,
COUNTY Of ;:,t: 11 JflJL
Tb., hng\)ing lnstrumentwasadm-'edgedbelilre me
this~ day of f.t~f(,at''t. . 20 a-t by
N-~-:~li~4 Personally Kr-, OR Produced kl/dmMltifil:alli"licltliu,1 __
Type of ldenti6tation
Produced~--------
Signature of Con!racturJljce Holder
STATE OF R.ORIDA c,~ 1, ,11 ~
COUNTYOF ...:,i. L,l,,<I..IU
The fQmQing i11strumJ!nt was admulllledged before me
1his ~dlciav of J<llw, ~ • 20°2-I by
M,~S,vie.. ..
Nameuf~ stab!ment
Pelsunallr Kll<Mn OR Pmduted lda""dilili,fitatitn..,,.... -n
lypeuf ldeutif.caliun ---Produced. _________ _
~ .(,.. ~_dL
{Signab.lreut Notary -~.&Utr~ '
• ,,,,. ,;,,..... CHRI ~\NE JOYCE CO~::-!.., .,,
. . -·" • ""-tt of Fl~•. '\'9" Ji)
(it~.; ~i) commlssion#GG984701 '~'fitf/ My comm. Expires AUi 21, 2024 '•,,,,,._.,.,:: l Mat.IN AUn.
REVIEWS FI\ONT ZONING SUPERVISOR PlANS VEGETATION SEA TURllE MANGROVE
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW