HomeMy WebLinkAboutJordan AC Change out permit app pg 2DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable -
Name: ________________ _ Name: _______________ _
Address: __________ ---=-----
City: ____ --c ______ State: __
Zip: _____ Phone. _________ _
Address:
City: __ -_-_-_-_-_-_,-;_-_-_:_-_-_-_-_-_-_-_-_-_-_~St-a-te-:~~---_-
Zip: ____ Phone: ________ _
FEE SIMPLE TTl1.E HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Address_: _____________ _ Name: ______________ _
Address: _______________ _
City: ______________ _
Zip: _____ Phone: ________ _
City! _______________ _
Zip: _____ Phone: _________ _
OWNER/ CONrRACTOR AFFIDVIT: ~ is hereby made to obtain a permit to do the-and installation as indicated.
I certify that no work or ins13llation has mmmenoed prior to the issuance of a pe,mit.
St. Lucie CQunty makes no~ that is granting a perl!lit wiH authorize the permit holder to build the su~ structure
which conflicts with any ilfll>!k:able Homeowners l'lssoc:iation rules,. bylaws or and covenants that n_,ay restrict or pri>lulJit such
structure. Please consult with your ~ Association and ~ your deed for any restrictions which may apply.
In consideration of the granting of this requested permit. I do hereby agree that I wffl, in aD respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit appiiCatlons are exempt from undergoing a fuH concurrency review: room additions,
accessory structures, swknming pools, fences, walls, signs, screen rooms and aa:essory uses to another non-residential use
WARNING TO OWNER: y_.fallure 1u Reca;d ,1 Notice of Cuwa1.a1CAi1-may l'l!Sllltin paying twiCle 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 attnrru>v before commencinll work or recordi r Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STA TE Of R.ORIDA <:-L_ f ,, ,..;,.
COUNTYOF ____ ~_..:..:...c.~......::"--------✓ Physical Presenceor __ Online Notarization Sworn to (or affirmed) and subsamed before me of
this ~day of O{;ft>bRC . 20i!I_ by
Name of person making-ent.
Personally Known ✓ OR Produced ldentilicaticn --
Type of Identification Produced. _________ _
~~.f!rnwd,(_
(Signature of Notary bl",c-Jtate .!)f florida)
Commission No. I ,.,;.J;_;..,.. __ ~HRllTINE JOYCE CONWELL -----,iH;,i:•· ~~~~" try Pu)llc · Stitt of FIOridl
\1!U(/.li commlmon , GG 98'701
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
·-~~~/ M.y Comm. ~lr.s ALI 21, 202.-
""1dtd thr""fh N1tlon1I Notlry 4ssn,
FRONT ZONING SUPERVlSOR PlANS VEGETATION SEA TIJRTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW