HomeMy WebLinkAboutONeil AC Change out permit app pg 2?xv
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: -
Address: Address:
City: State: ---City: State: ---
Zip: Phone Zip: Phone:
FEE SIMPLE TmE HOWER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun.s1 makes no representation that is granting a permit will authorize the ~rmit holder to build the subject structure
which is in co ict with any applicable Home owners Association rules. bylaws or an covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recordin11: vour Notice of Commencement.
~7.6'~ ~~~
Signature of owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder -
STATE OF FLORIDA S\-. l.udL STATE OF FLORIDA I
COUNTY OF COUNTY OF 'St. WC(e.,
~om ~(or affirmedl-a.!!.d subscribe~ore me of Sw~or affirmed) and subscribed before me of
\I J;a! · ~nline Notarization __ Physical Presence or __ Online Notarization
!-,this _ll_¼-nay of l A ,. · -202!1 by this J:?l':,day of Mais, . 202f by
~~~~!rs~ m~~ement.
M1~€! f &~[v
Name of person making tatement.
Personally Known ✓ OR Produced Identification ---Personally Known / OR Produced Identification
Type of Identification Type of Identification
P~ed -Produced
'.4?~/N";,/J 1 (' -~// ·12t~A---'.g {l __ /(; -,ae_
"
(Signature of Notary P ~ic-State of Florida) (Signature of Notary IY;blic-State of Florida )
Commission No. ' l~.i!ri.:· .. CHRIITl•~w CONWEcL Commission ~ ..,:;,,_,_•. ........ CHRISTIN£ Jove,,~ -~~I) , . iii., 'otiry Pub • tt of F!oridl 'i~\ aut11, ~0011,. St"' of ·"'" \i PJ./ ~ommis!i~ # GG 91•701 \';'" "'i Commls~lon :; GG ,s_,-i701 ·-.,. -~, ... ·• .. ,, jjl•• j,,• • .,\ .,.....,. ·,. ,. - -..
Sun t<I throUlh Nation, Not1r;r Assn. ..... ""eondt<I th tlUlh Natksna! Noury As ~-.
REVIEWS F, ,,., OR PlANS V ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. -1 .... , _..,