HomeMy WebLinkAboutLewis AC Change out permit app pg 2DESIGNER/ENGINEER:
Name:. ________________ _
Address:. ________________ _
City: ____ -=-_____ State: __
Zip: _____ Phone. _________ _
_ Not Applicable MORTGAGE COMPANY: Name:. __________________ _
Address=-------------=-----City: ____ =-=-_______ State: __
Zip: ____ Phone:. _________ _
_ Not Applicable.
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:. _________________ _
Address: ______________ _
City:. ____ --=-,------------Zip: _____ Phone: _________ _
BONDING COMPANY:
Name~=-------------------Address: ________________ _
City: _______________ _
Zip: _____ Phone:. ___________ _
_Not Applicable
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 J>e!111it will authorize the permit holder to build the subject structure
which is in conflict with any applicable Horne Owners Association rules, bylaws or and 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 attome before commenci work or recordin our Notice of Commencement.
Signature of OWner/ Lessee/Contractor as~ for OWner
STATE OF FLORIDA 5\-l.udL
COUNTY OF •
Swor/io (or affirmed) and subscribed before me of _V_i, Phh;ysical Presence or __ Online Notarization
this J-iLdayof ,:f!.U\l_ , 202, by
tl~:~r!m~~ement.
Personally Known ,,/' OR Produced Identification __ _
Type of Identification
Produced·--,,-------.----rJ>---
Signature of Contractor /License Holder
STATE OF FLORIDA c .1.-1 , ,,.;,.
COUNTYOF _____ ;:)_,,_._UJll,;.IC.., ___ _
SwornL(or affirmed) and subscribed before me of
__ Vpt.';sical Pre::'.nce or __ Online Notarization
tis ]-!'--day at ~e, , 20]1 by
N~~rsonf:mat!'tl~ent.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced,.--------,,,----,,,-.......-
Public • Slit• of F
t GG 984701
m, El:~frts Au121, 2024
ry un.
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION SEA TUR
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
REVIEW REVIEW REVIEW