HomeMy WebLinkAboutPerez AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCTION UEN lAW INFORMATION: -
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 Appflcable 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 wor1< 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 ~resentation that is granting a per!!lit will authorize the permit holder to build the subject structure
which conflicts with any apfl!tcable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and l'1'!V1eW your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I wiU, in all respects, perform the wor1<
in accordance with the approved plans, the Rorida Building Codes and St. Lucie County Amendments.
The following building pennlt 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 Recorda Notice afCammentementmay 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 attornev before commencinrz work or recordinrz vour Notice of Commencement.
Signature of Owner/ Lessee/,Eontractor as Agent for ~
STATE OF FLORIDA 01 I ..• '.n
COUNTY OF Y, {..l,{,Cl-c..,,
Sworn to ( or affirmed) and subscribed before me of ~cal Presence or __ Online Notarization
this~dayof Oci12h4-:C , 20-1=!_by
_11!,0.J&~
Personally Known --'---OR Produced Identification __
Type of Identification Produ~d-
~ ~. ~,a_,
(Signature of 'iii~"'~., C~~ISTINE JOYCE CONW[ll Commission " ·;:E Notary Pub~~~• of F1orid•
\ •· 1;011111,lssftm'Ti!fG 98 ◄701
·-.,,., .~ · My Comm. ExpirtsAut 21, 202 ◄ 1 IO<Ultd throUf/l Nllt10NI Notary .\osl,,
REVIEWS FRONT
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SUPERVISOR PLANS VEGETATION SEA TURlli
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MANGROVE
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