HomeMy WebLinkAboutBluemel AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCTION UEN lAW INFORMATION:
DfSIGNfR/EN6INE _ Not Applical>le MORlGAGE COMPANY: _ Not Applicable
Name: ' Name:
Address: Address:
City: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPI.£ TmE HOlDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTMCR>R AFRDVIT: Applitation is hen!by made to obtain a permit to do the work and inslallation as indicated.
I certify that no wort or mstaUa!ion '1as mmmena,d prior to the suana, of a pemut.
St. Lucie Coun1Y mal<es no tl!p" e itali...1 thati,. g,auling a p,!!fflitwill authariJe the l)l![lllit hokier tn build the~ structure
• which is in mnllid: with~~ HomeOwiiers ~ ial►•• Alles, bylaws or and cmienants that mav. restrictorlll!)hibitsuch
structure. Please QJIISUltwilfi yaur Home OWnersAssociationand review yourdeed fur any1est<ictimb vihich may apply.
In consideration of thegra111ingofthis requested permit, I do hereby agree that I will, In aB respects, perform the wodc.
in aca:mlaP<:e wilh the app1<M:d JGRS. the Florida Building Codes and St. l.ucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swilm11iug pools. fences, walls, signs. saeen rooms anrl ao:essory uses to another RGIH1!Sidenlial use
WARNING TO OWNER: y_.failure to Reamt a Notim uf Comme...:etnellt may resultln YQUI' paying twice 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
commendn work Of" ,eco,di ur Notice of Commencement.
Signa~ 7l5seef0lntra<1or~~
~~Fo'}ORIDA Sr, Ll)-QIL
The~ instrume!'twas admowledged before me
tllis~ day of ~ I • 201!_ by
~ f. ~
Nameofperson,maldng
PersoOiilly Koown __J/_ OR l'nlduced ""ldecr.....tiitit"-~.ca~1oon __
Type of ldentifu:ation Produced,__ _______ _
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLErED
Rev.8/2/17
RIST £ CONWEL(
ry Publk • Slit• of Florido
om mission , 0G 98'701
COUNTER REVIEW REVIEW
Signature of Caodladm/tic;ense Holde<
STATEOFR.ORIDA <::;,J... f .• ~•-~
COUNlY OF i'...J! , UJluK_.,
The forgoing ~epi was acknowledged before me
tllis~day of fi¥J1 . 202A by
Micka.et F. B>it
Name of persoO'fnalcmg Sia
Personally Known_.c..1/_ OROR Pr Produa!d Identification __ _
Type of ldentilication Producede-________ _
~}tf:,.::::
. Pl.ANS
REVIEW REVIEW REVIEW
I)
MANGROVE
REVIEW
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