HomeMy WebLinkAboutMeade AC Change out permit app pg 2SUPPU!MENTAL CONSTRUCTIONLIEN.LAWINFOR'MAllON:
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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 pennit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a pennit.
St. Lucie Countv 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 ma),'. 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 pennit, 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 pennit 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 attome before commencin work or recordin our Notice of Commencement.
Signature of owner/ lessee/Contractor a~ for Owner
STATEOFFLORIDA 5\-{Ud,_.
COUNTY OF •
Swor~or affinned) and subscribed before me of
:.:v;~lcal Pr~nce or __ Online Notarization
this _1--fh_ day of Jani.., . 202q by
tl~~~r! m~{!:tement.
Personally Known / OR Produced Identification __ _
Type of Identification
Produce.,_ ____ ~--~--
CONWELL
• \ Not1ry Pub lit · Stitt of Florldl
Commission No. ! Commi,sio(Sll,0)9!<701
-+',~~ ---· My omm. Expires A1.11 2 t, 2024
'.'!ondtcl throu1h N1t'i.on,1I Not&ry Assn.
Signature of Contractor/License Holder
STATE OF FLORIDA c ~.1 ,.,.;.,
COUNTY OF _____ ;::i._,_11.JJ'U __ l--' __ _
Sw~to (or affinned) and subscribed before me of
__ Physical Presence or __ Online Notarization
this .:J1!: day of :Jl,.,no . 20291 by
N~~o~mat:!'t!'t1ment.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced:----------,~--
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