HomeMy WebLinkAboutStaton AC Change out permit app pg 2DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable.
Name: ~----------------Address: _______________ _
Name: Addres._s_: _______________ _
City: ___________ State: __
Zip: _____ Phone _________ _ Otv=-----.--------'State: Zip: _____ Phone:. __________ _
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: ________________ _ Name: _________________ _
Address:. ______________ _ Address: _______________ _
City:. ____ __,~----------
Zip: Phone: ---------------
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 commenoed 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 ~icable Home Owners Association rules, bylaws or and crnienants that mav. restrict or l)r!lhibit 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 apprO\led 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 faDure 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 r Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner -
STATE OF FLORIDA S\-LudL
COUNTY OF •
Swor/to (or affirmed} and subscribed before me of
X~~ical Presence or __ Online Notarization
this_l5-t'-, day ot$f ¢tmbu: . 202fl by
tl~~~ m~~tement.
Personally Known / OR Produced Identification __
Type of Identification
Produced, ______ ,, __ _
Commission No.
REVIEWS
DATE
RECEIVED
FR
COUNTER REVIEW
E CONWELL
lt'c--,. Statt of Flo 1
REVIEW
Signature of Contractor/license Holder
STATE OF FLORIDA c .1. r , ,,.).,
COUNTY OF _____ -;:,_,,_._~ ___ _
S••-~L(or affirmed) and subscribed before me of _-_Vo Pi:hys"ical Presence or Online Notarization
this ISi< day of S°ftrmW:: , 202f by
N~~~mat¾{~enL
Personally Known ✓ OR Produced Identification __ _
Type of Identification
Produced ____ -=----,,---
~ -~.ea,
PtANS VEGETATION SEA nJRTLE
REVIEW REVIEW REVIEW
MANGROVE
REVIEW