HomeMy WebLinkAboutPulver AC Change out permit app pg 2SUPPI.EMBffAl CONSTRUCTION UEN IAW INFORMATION:
D£SIGNElt/ENGIN£ER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State:_._ City: State: --Zip: Phone Zip: Phone:
FEE SIMPLE TITlE HOlDER: ~ Not Applicable BOND1N6 COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACRJRAfRDVIT:Applicalionisherehymadetoobtainapennittodotheworl<andinslallationasindicated.
I certify that no worlc or ;nstaffation has oommenced prior to the issuance of a permit_
• St. Lucie County makes no '""' es ltiitioo that lsgnmtjng a~ will authorize the Dfflnit holder to build the subject structure which is in c:onltictwilhapy~ble "omeOWmn .\<sociallon..., bylaws or and mvenants that may restrict or pr!)hibit such
structure. Please consult"'t""" with-your Home Owners Association and review yoordeed for' mfy restlictions which may apply.
In amsideration ofthegiar1tl11gofthis requested permit, I doherehyagreethatl will, in aB respects, perform the work
in acmrdam:e wilh the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undetgoing a full concurrency reviE!w: room additions,
:accessory structures, swimming pools, fences, walls. s1gr15, saeen rooms and ., , ew • r uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commmic:ement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. tF you intend to obtain financing. consult with lender or an attorney before
comme · work or recordin ur Notice of Commencement.
Sqps~~~fofjvm
STATE OF FLORIDA C:::: 1 I ,.,,:11
COUNTY OF U,: 1..MQ,:;.,
The ~instrumentwas acknowledged before me
this~dayof ~ .20.2.1 by
Na~~~~-Personally Known OR Produced lde,lrl,,,mllililio~.car:11oon __
Type of ldeimlication
Produced~--------
Commission No. CHRISTINE JliGllo.wm
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
Notary Public• Stlt• of Flartdt
Commlsilon # GG !S:.701
COUNTER REVIEW
• "·
REVIEW
Signature of ContracmrJUcense Holder
STATE OF RDRIDA <;:.L I , .,,;,,
COUNTYOF ____ '-11_ •• _l-vuc:,., ____ _
The~ insb:t!menJ was acknowledged before me
thts~dayofJ'IW'{)1 .20U by
M,~S>i!, Name of . sta t
PefSOnally Known _ _,__OR Produced ldentiftcalion __ _
Type of Identification Produced.____ ________ _
Pl.ANS VEGETATION SEA TURllE MANGROVE
REVIEW REVIEW REVIEW REVIEW
' ./