HomeMy WebLinkAboutLWPPOA AC Change out permit app pg 2 PCX
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DESIGNER/ENGINE£R: 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: TNot 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 insulation as indicated.
I certify that no work or installation has comfnenced prior to the issuance of a permit-
St. Lucie County makes no representation that is grafting a permit will authorize the it holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ar�d mvemnts 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 5t.Lude 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;obsite before the first inspection.If you intend to obtain financing,consult
with lender or an attorney before commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA n'�.
COUNTY OF COUNTY OF
Swo to(or affirmed)and subscribed before me of Swo [or affirmed)and subscribed before me of
Phy ical Presence or Online Notarization Physical Presence or Online Notarization
this UhAday of 202 f by thisIZ4 day of 2020 by
fic al F.
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Name of person makirig statement. Name of person making lament.
Personally Known Z OR Produced Identification Persohally Known ✓/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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Corn- :1 Commission rL, CeRm. :ti(*#Q �,.1n�- Commission No °! )Ay Comm. _ti es At
ough' ' Notary«adr..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REMEW
DATE
RECEIVED
DATE
COMPLETED
eV.