HomeMy WebLinkAboutHurricane Shutters AC Change out permit app pg 2DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: ________________ _ Name: _______________ _
Address: ______________ _ Address: ----------------City: ___________ State: City: ____________ S. tat e:
Zip: _____ Phone _________ _ Zip: _____ Phone: _________ _
FEE SIMPLE l1TlE 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 instaHation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes r,o re,pr..scutation that is granting a perJ!'it will authorize the permit holder to build the sub~ structure
which conflicts with any llPJ!!IC3ble Homeowners 1'ssodatioil rules. bylaws or and «>venai ,ts that may restrict or prohibtt such
structure. Please consult with your Homeowners Association and ..,._your~ for any restridions which may apply.
In consideration of the granting of this requested permit. l do hereby agree that I wiU, in au respects, perform the work
in accordance with the approw,d plans, the Florida Building Codes and St. Lucie County Amendments.
The following building: permit applications are exempt from underguing a full concurrency review: room add"ltions,
accesso,y structures, swimming pools, fences. walls. signs, screen .--ns and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Realld a Notice of Coim-nent ,""J result In paying twice fur
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
ith le de bef . rk d" of w n r or an attomev ore mmmencml!'. wo or recor IOI!: vnnr Notice Commencement.
~'YL!~~
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORIDA St.~ COUNTYOf
Swo~ {or affi?kTJ and subsaibed before me of
this dayot_\2tr ,20..1:l_by
✓Physical Presence or __ Online NotanzatiOn
Name of person making statement.
Personally Known ✓ OR Produced Identification --
Ty~c:ation Produced
. ~ CL ~RP.-
(Signature of Notary 7f'ic-State ~ Florida) _
Commission No. /" .,,,, . CHRISTINE_ JOYCE CONWELL
. , i Notar, Pub he• State, of Florida
1 \ ~/ Commlulon # GG 984701
'··•,,.'!!,.,,., .. / My Comm. £xpire,s Aug 21, 202 ◄
I Bondt< thr0\/ih Notion~ Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTlE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ru::v . '