HomeMy WebLinkAboutCovello AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCTION LIEN IAW INFORMATION:
D£Sl6NER/ENGINE _ Not Applicable MOR16AGE COMPANY: _Not Applicable Name: Name:. _______________ _
Address: Address: ______________ _
Ctty: ____ ...,,.,. _____ State:_. _ City: __________ --'State:
Zip: _____ Phone.__ __ --'-------Zip: ____ Phone:.__ ________ _
FEE SIMPLE TITlE HOlDER: ~ Not Applicable BONDING COIIPANV: _Not Applkable Name:.__ ______________ _ Name:. ________________ _
Address:.__ _____________ _ Address: _______________ _
Ctty:~----=----------Zip: _____ Phone:.__ ________ _ City:~-------------Zip: _____ Phone:. __________ _
OWNER/ a>NJRACIORAFRDVIT: '1141&1 ai;,-. isberehv made to obtain a pennitto do the wort and iDslitllafinn 'IS indicated.
I certify thatnowoncor installation ha, C011m1'!iKed prior ID the issuance of a pennit.
St. l..utie Col.l1tv makes no rep1ese11talio11 that isgranl!nga ~will authorize the permit holderto build the~ structure
• which is in conllict with ~'T'llii able Home Owners ,•z i;mon rules. bylaws or and mvenants that may: restrict or-Pf!lhibit such
strudure.. Pleasemnsult""'nm"''°"'" Hwoe Olmers-➔ ia!iw illld .-yourdeedfar ""1'1estlictiuns which may ajiply.
In cunside,alion ufthegiantiug ufthis req,il'S!PII permit, I do hereby agree that I will. in all 1espects, perlom, theworl<
in accunlana! with the appruued plans, the Ronda Building Codes and St. Lucie Counly Amendments.
The fulkNlil1g building permit applications are e,,empt from undetgoing a lull aJIIDlffl!llC¥ review= rooa, additions.
accessury 5tructure!i, swilmni111g pool';, fences, walls, sigt1S, screen TIIOIIIS and + 1 ess-y uses ID anulhe,-1101He-idential use
WARNING TO OWNER: Your failure to Rec.ord a Noliceaf ComiiiEi..anent may result in,_-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
commendmr work or-reconfina unur Notice of Commencement.
~~kL?f/f_~
STAT£OFRORIDACJ..1 r111}n COUNTYOF ___ Dl_-'-'"'-v' __ v _______ _
The furgoiog instrument was acknowledged before me
this~ day ot li:f ri I • 20 Z1 by
tJvjae,lf. ~
Name ofpersonfoaking
PersonallyKnown__j/_ OR Pmdum:l ldenlilication __
Type of Identification
Produced.__ _______ _
Signature or Cunbactu./lJ,:ense Holder
SfATEOFR.ORIDA Cl fu&v COUNTYOF ____ ~JC.=-...:..::-----
lhefmgoing~was acknowledge!l before me
this_~_ da\dayof~I .20ZI by
2i~~!!l~ Pel;onally Known_~_OR Produced ldei""ltll..,1catio,""""'" -n __ _
Type of ldenti6catiim
Produced _________ _
~ 9. ~a,( _.,_. ___ _
Commission
L
" O µ,:,.. CHRISTINE Jolee of F1orldl
;,,.,;, Notary Publl< -State I
S,>',' -# GG 914!1f,a9
'-k<f! ,;.ytomm, Exp\re,Augll~fOl
-~ .. ~.f .. f.'iBonded throut,h Mat\ona\ Wota~ As,,;l'I,
REVIEWS FRONT ZONING SUPERVISOR Pf.ANS VEGETATION SEA TURilE MANGROVE
DATE
RECEIVED
DATE
COMPLEfED
Rev.8/2/17
COUNTER REIIIEW REVIEW REVIEW REVIEW REVIEW REVIEW