HomeMy WebLinkAboutKennedy AC Change out permit app pg 2DESIG ENGINEER: -Not Applicable MORTGAGE COMPANY: _ Not Applicable ·
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE T1TlE HOLDER: _ Not Applicable BONDlN6 COMPANY: _Not Applicable Name: ________________ _
Address: _____________ _
City: _____________ _
Zip: _____ Phone: ________ _
OWNER/ CONIRACTOR AFROVIT: Application is hereby made to obtain a permit to do the wort and installation as indicated.
I certify that no worlt or install--. has commenced prior to the issuance of a permit.
St. Lucie County makes no~ that is grantin11 a permit will authorize the permitholderto build the ~structure
which conflicts with any app!icable Homeowners MSOCialioil rules. bylaws or and oovenants that-restrict or pri,hibit such
structure. Please consult with your Homeowners Association and rev,ew 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 aU respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following bwlding permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, saeen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to R-,t a Notice of ColmaleilCelMnt 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 recordino vnur Notice of Commencement.
~ ~ ~':JI,~
Signature of Owner/ lessee/Contractor as Agent for OWner
STATE OF FLORIDA S\-. ~ COUNTYOF
Sworn to (or affirmed) and subsaibed before me of
this ~ day of l'ld-obtr , 20 :M by
%hysical Presence or __ Online Nol3rization
Name of person making statement.
Personally Known ✓ OR Produced Identification --Type of Identification Produced
17 l1,/itM1R. ( .. ,A . ,,,, //_
(Signature of Notary • ,i>!i'~ CHIIJ)T)NE JOYCo CO•WELL V
Commission No. !i. ,,. :· ... ~·~ Puillc. Stilt of Florldl
'· , mllllon I GG 911701 1
·-..:.~ f\1, . ....-My Comm.= Aut 21, ~
............. dtd thrOll9h Na 11 Notlr)' ·
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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