HomeMy WebLinkAboutPylant AC Change out permit app pg 2SUPPLEIOIENTAL CONSfRU(:;tlON lJEtll lAWl~MAllQt-f:.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: -
Address: Address:
State: City: State: City: -----
Zip: Phone Zip: Phone:
FEE SIMPLE ffiLE 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 reJ)re!ientation 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 mav. 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: roorn 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 attomev before commencine work or recordine 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 5\-. Ludt.. STATE OF FLORIDA St.~ COUNTY OF COUNTY OF
Sw~o (or affirmed) and subscribed before me of Swo~(or affirmed) and subscribed before me of
__ Physical Presence or __ Online Notarization __ Physical Pre~ce or __ Online Notarization
this Zfto--day of ;f,,41 . 2021( by this~ day of Lit) • 202r{by
tl~~~!m~~tement.
M.~ P. &~[~
Name of person making ~tatement.
Personally Known ,,/ OR Produced Identification ---Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced
(l~
Produced
~ ~ a. ~d(._
(Signature of Nota?ic-Stat<> of flnr;.a~ ' (Signature of Notary ~ic-State of Florida ) _ ·c C
• _ 1 .--~•t CHRISTINE J0VCH0NWELL /.m·· CHRIS:INE.JOVCHON~) Commtsston No. ,~~-, Nour;{&,al} State of Florido Commission .. \I fA} Commission# GG 98.4701 ·. c -State af \ij /J),J Commission# GG 984701 \,. 'N,,/ My Comm. Expires Aul 21, i014-\.. ./ u, r ...... m. c-.... lrn.tu•l~ -a02'-J ... , ...... ·-···· "" ' Bondtdthr "11h Natlonol Notar; .., '
REVIEWS FRO"' SUPERVISOR PIANS ' oANGROVE . --• t ..... ,,-LC
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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