HomeMy WebLinkAboutThoenissen AC Change out permit app pg 2 - Copy.pdfSUPPLEMENTAL CONSTRUCTION UENtAW INFORMATION: . . .
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable .
Name: Name:
Address: Address:
State: City: State: City: -----
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 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 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, watls.,. 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 recordinl! vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder -
STATE OF FLORIDA Stl.udt. STATE OF FLORIDA '
COUNTY OF COUNTY OF ~t.Lue!e..
~ to (or affirmed) and subscribed before me of S~o (or affirmed) and subscribed before me of
Physical Presence or __ Online Notarization __ Phif.!cal Presence or __ Online Notarization
this ~day of Cfi,L-1'1.L • 202ff by this Zll ay of ::TLM<-<-. 202f by
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1
!:tement.
Mr~ f &'ifeL
Name of person making atement.
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification ---Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Pub ;'. ··,t li~Jik. 5,.,.-~ ,1;rtd, (Signature d lileu~=JdYCE CO~WEL: \J f/ Commission fCiG 984701
Commission No. ·• ....... !Y---·· MyC~~resAu121, 202 ◄ Commission ' ~/ Notary Publ~c. St1t• of P~~
ded 1hr I ional Notary Assn. ·-o ,. / Commission# GG 9847
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ondeo thr0 uth National N-' -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. -, -,