HomeMy WebLinkAboutViscido AC Change out permit app pg 2SUPPLEMENTAL CONSTRtltftON.UEfft:AW~ffijf; . . · <,! ; •; .· .
.-' . . . "' . ' . ; . . . ,,_ . . . ' -.. ' . . . ... . . . ' .. ,,·. .
DESIGNER/ENGINEER: _ 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: _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 Aorida 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 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 commencimz work or recordin2 vour Notice of Commencement.
~~.6'~ ~~~
Signature of Owner/ Lessee/Contractor a~ for Owner Signature of Contractor /License Holder
STATE OF FLORIDA S\-. Lu&. STATE OF FlORIDA ' COUNTY OF COUNTYOF ~t-~
Sw~ (or affirmed) and subscribed before me of Swo~(or affirmed) and subscribed before me of
--{j,ical Presence or __ Online Notarization --;;;teal Pres~ or __ OnHne Notarization
this r. day of 'S e.r.£ • , 202f by this day of ~ . , 202d by
tl~~~! m:trL~ement
MfcMtf f &tL
Name of person making tement
Personally Known ,/ OR Produced Identification ---Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(1 _j,. :7(UA(/ ( I fl_,. -·uL. f'.i.·~-~-Q ((. ,_d,( -_.,,,J ........ .
(Signature of Notary 1i --(Signature of•···· · -... . . ' (~~ CHNISTINE JOYCE CONWELL • 'i~"-$ CHRIS™E JOYCE CONWELL Commission No. \ Not,., Statt of Flortd1 • '. f Co t GG 98 ◄701 Commission No. [, • ..,,\ NotaryPublk-Stat~rd•
··;,:-~~~_..-My Comm. Expires •ug 2,, 2024 ~ f \..ummlss.lori'.f GG 98470
"'""Bor,C:!d-throu•h National Notary ASSn. ·-1~~.--My Comm. Exp!rfl~ua 21, 202-4 1
rn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. :>/b/2.U