HomeMy WebLinkAboutBouchard AC Change out permit app pg 2.pdfSUPPLEMENTAL 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 TITLE HOLDER: _ 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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that mav 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 concunrency 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 attorne before commencin work or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner -
STATEOFFLORIDA 5\-LudL
COUNTY OF •
SwQm to (or affirmed) and subscribed before me of _v_ 1 Physical Pre~nce or __ Online Notarization
this 2!£ day of :;}LUJ,l. • 202f by
tl~Ce~rs~ m~(~tement.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced ----cc;----,,,----
Commission No.
toNWEct·
otary Public-Stitt of Florid•
commlss\O!"l~ffl-4701
c.....,,-,{<,mm. Expl,'fffll'21, 202•
· ..... Bonded throUjh NatiOflal Not1ry Assn,
Signature of Contractor/License Holder
STATE OF FLORIDA c:;:, .1.._ r ,.,.;.,
COUNTVOF ______ ;::,,t_W'U __ t.,.., __ _
Swo«i"to (or affirmed) and subscribed before me of ✓-Physical Presence or __ Online Notarization
~ day of Jv,Af . 202/J by
Nt!f~'!!!sof mat:!~~ent.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced _____ ~-~---
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION
REVIEW
SEATlJRnE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
REVIEW REVIEW