HomeMy WebLinkAboutDavies AC Change out permit app pg 2 - CopyZ
)ESIGNER/ENGINEER: Not I
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 Courtly 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 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 bite 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
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA JT.
COUNTY OF
Swo to
K(or affirmed) and subscribed before me of
Ph irai Presence or Online Notarization
this day ofZra6 F 202E by
Name of person makidtg statement
Personally Known Z OR Produced Identification
Type of Identification
(Signature of NWMfikc-e of FloridaCommission No.HAI�TINE JOYCE CONWELLary PUNC 4�korid�Commission # GG 994701Comm. Expire Aug 21, 2024
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RECEIVED
DATE
or recording your Notice or
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Signature of Contractor/License Holder
STATE OF FLORIDA 42 1
COUNTY OF
Swor_ sy' (or affirmed] and subscribed before me of
Ph ical Presen a or Online Notarization
this day of 202p by
Sv�/f ,
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary?Wic- State of Florida
JOYCE CONW �
F• Sute of F
on K GG 984701
Bonded thrash National Notary
PLANS ANGRG
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