HomeMy WebLinkAboutAlfonso AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCllON l.lENtAWlllFORMA.11C>ij: .. . .
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: .
Address: Address:
State: State: City: ---City: ---Zip: Phone Zip: Phone:
FEE SIMPLE TITLE 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 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 add"otions,
accessory structures, swimming pools; fences1 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 attorne before commencin work or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner -STATE OF FLORIDA 5\-LudL
COUNTY OF •
Swout'to ( or affirmed) and subscribed before me of
Vi,h;,,.ical Presence or __ Online Notarization
~ day of A11~(S.f: . 202• by
M~~~r!m~{~ement.
Personally Known / OR Produced Identification
Type of Identification
Produced ______ ,..... ___ _
Commission
•
My Comm. Expire, •ii !~
ondtd throujh Nat1001I Mota'ry-rss'n.
Signature of Contractor/License Holder
STATE OF FLORIDA c .1... 1 , ,,.;..,
COUNTY OF ______ ;:),I_~--~---
Swo~/o(or affirmed) and subscribed before me of
__ Vph;sical Presence or __ Online Notarization
this 2lll\. day of ~t , 2021/ by
N~~so~maB!'Ll't:rnent.
Personally Known / OR Produced Identification __ _
Type of Identification
~odocM~----------
NWELL
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m. ExplmAu121, 202◄
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REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
REVIEW REVIEW REVIEW