HomeMy WebLinkAboutBrimhall AC Change out permit app pg 2DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: -----------------Name:. _________________ _
Address:. ______________ _
City: ___________ State: __
Zip: _____ Phone _________ _
Address: ____________ -___ _
City: ___________ ---'State:
Zip: _____ Phone:. __________ _
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _ Not Applicable
Name:. ________________ _ Name: _________________ _
Address:. ______________ _ Address: -----------------City:. _____ .,.,.. __________ _
Zip: _____ Phone:. ________ _
City: ________________ _
Zip: Phone: -----'-------------
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worl< and installation as indicated.
I certify that no wor1< or installation has commenced prior to the issuance of a permit.
St Lucie County makes no re~on that is granting a fll!!1Tlit wt11 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 may restrict or pl'!lhibit 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 roorns and accessory uses to another non-residential use
WARNING TO OWNER: Your faHure 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 commend work or recordin our Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner -
STATE OF FLORIDA 5\-L.udt.
COUNTY OF •
Swor/to (or affirmed) and subscribed before me of V Ph~ical Presence
1
or Online Notarization
this 2151--day of ;:Iu. ~--, 202t by
tl~:~1! m~~tement
Personally Known / OR Produced Identification __
Type of Identification
Produced. ___ ---.,---,..,.----
Signature of Contractor /License Holder
STATE OF FLORIDA c .L.-r , ,,.:.o
COUNTY OF _____ ";:)_,1_._1,.1,11Uv ___ _
swo~...t(or affirmed) and subscribed before me of
__ Vphysical Presence or __ Online Notarization
this ~'oay of .,:r~ , 202p by
N~~rsonemat!~ent.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced _______ ,.. __
. ~dl
ic-State of Aorida l
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS ANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLITTD
ev.
REVIEW REVIEW REVIEW REVIEW