HomeMy WebLinkAboutOrtiz AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCTION UEN IAW INFORMATION:
DESl6NER/ENGINEER: _Not Applicable MORTGAGt COIIIPANY: _NotAppticable
Name: Name: -----------------Address:, _________ ~----Address: __________ --=----
City: __________ State:__ City:-----,::-:----------"State: __
Zip: _____ Phone, ___ _;________ Zip: ____ Phone:,__ ________ _
FEE SIMPLE m1.E HOLDER: ~ NotApplicable BONDING COMPANY: _Not Applicable
Name: '----------------Name:. ________________ _
Address:,__ _____________ _ Address: _______________ _
City:'----------------City;'------------------
Zip: _____ Phone:'-----------Zip: ____ P hone:c..._. ________ _
OWNER/ CONIRACIORAfflDVIT: Aj4ilil a••·· is hereby made1n oblaia a pemtittn do the work and iPS1 U f:;1 as indicated.
I certify that no work or installation has mmmenced prior tn the issuance of a permit.
• St. Lucie Countv makes no re,..w1..11tatiun !hat isgrantjng a ~will authorire the oermit holder to build the~ structure
which isin conDict wilh i"..t,ill4ilil able IUneOwners Assu ial►.A• ;ulw, bylaws or and mvenantsthatmay: restrict orpl!Jhiblt such
structure. Pfeasecunsalt~..--you.-Home011ner5 Assol iali•w• .ad review your deed far a,,y1btllictiuns which may apply.
In consideration aftheg.a,dii,gufth"-•ecp-ed p,,rmi!. I du hereby agree that I will. in all respects, perform the work
in a«urdance with the apprull@d plans. the Florida lluildmg Codes and St. Lucie County Amendments.
The following building pennit applications are e,emptfmm '-"llecguing a full mnmrrency rf!l!iew: room additions.
accessmy structures, swinu1lil,g pools, fem:es. walls. signs, screen JOOmS m.d aa.wso1 y uses to another non-residential use
WARNING TO OWNER: Yourfailun!to Rea:ri a Nolie.em Comne,. eot may result in your paying twice for
improvements to your property. A Notice of commencement must be remrded and posted on the jobsite
before the first inspection. If you intend to obtain financing. oonsult with lender or an attorney before
comm · work: orrecordirnr vnur Notice of Commencement.
The forgoing instrument was ad::.; nderfged '--!fure me
this~ day of M~ . 20'2-l by
~f.Bo~
Name of~
PersunallyKnown--¥-OR Produced ldenlifimion __
Type of Identification Producec:1. ________ _
(~J~_4=f1
Commissiuo Nu. (Seal)
--1.:ri:·~~; .:~~···· .. ,~C~H~~IST~l~N.;J,.OY~C.~c·s• .. w·n .. ,...,
1-----~--l-l!'~l'l,,I' .; •ot,ryPubll .•·
Signature of Contractor/license Hokier
=::~A a:-kre.,
The ~instrument was acknuw!edged before me
thisJlr!'.'..dayuf IIA.D.j • 20~ by
-Mi~*~~ Pel50llallyKnown,_'--OR Pnxlua!d klEnlilk:atiun __
Type o{ Identification
Produced, _________ _
(Signatureuf NotaryPuJaljl!-Slale of Florida l
;":,t> ;, Pletel") P~ll.tc.• Stitt o~ffi'fftfl
Commission, k.,·..iam·"ii""··... CHRISTIN£JOYCHO#ll..l,,
;'ii~ :di Commlsslol\ t GG 984701 \~.9!..r:lf./ My Comm, Expl(,es A~i 2,, 202'4
..._ ~11!1< #GG91!70T
. . . . h ~ i~_.a4_Pl.ANS __ -4-_w_GE_1_A_:TION __ +-SEA--1UR11.£----I--M-ANG __ R_o_VE---l ~ REVIEW REVIEW REVIEW REVIEW
REVIEWS .
mt
DATE
RECEIVED
DATE
OOMPLEfED
Rev.8/2/17
.,