HomeMy WebLinkAboutCeraso AC Change out permit app pg 2SUPPLEMENTAtCQ~U£:N·IAW~tlON:·•··•···· .... . .. · .. · . • .·
' ' . ';'' ·-' ,-. ' ·---'·, ' . . . . . .
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 pennit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to lhe issuance of a permit.
St. Lucie County makes no ~ntation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any app6cable 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 wil~ 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 appfications are exempt from undergoing a fuff 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 commencine: work or recordine: vour Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner -
STATE OF FLORIDA 5\-lu&..
COUNTY OF •
Swor/to (or affirmed) and subscribed before me of V Ph'vsical Presence or Online Notarization ~ day of SofkrnW:--. 202, by
M~~~!m~~ement.
Personally Known / OR Produced Identification __
Type of Identification
Produced
~ g.z,;;:;aL
(Signature of Nota{{Public-State of Aorida )
--
Commission No. --'17l'~--,-.. GJ;···i!i >:•·t:·· .. ' CHRI CE CONWELL
\.:~•[: 4ii-'] .... '., Notary Pwo,lc • Stato of Florld•
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
• Commosl.., # GG 914701
FR-" ~•• .. ~.!:-:a· ~'i 1..omm, ;;;r'" AUj Z1, ~uJ;,4
COUNTER REVIEW REVIE
R
Signature of Contractor /License Holder
STATE OF FLORIDA c:, .1.-1 ,.,.;,,,
COUNTYOF ____ ~_,_1--~----
SwornL(or affirmed) and subscribed before me of
Vp~sical Presence or Online Notarization
this zil"' day of ~ • 202~ by
MAAt# r:: &t✓
Name of person making tement.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced ____ -;:---,,-----,-~~-~ ,
(Signature · · • -· ,
PLANS
REVIEW
VEGETATION
REVIEW
...
SEATURTL£
REVIEW
MANGROVE
REVIEW