HomeMy WebLinkAboutCusimano AC Change out permit app pg 2 SUPPLEMEWAL.MWMUCTION,UEN tAW INFORMATION.
DESIGNER/ENGINEER: __Not Applicable MORTGAGE COMPANY- �Nat Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TrIU 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 permit to do the work 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 representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners 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 will,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 applications are exempt from undergoing a full eoncurrency review:room additions,
accessory sbvctures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residerrdai use
WARNING TO OWNER:Ymw failm to Record a Notice of Canmericenumrt may retain 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 Ott before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA cL
COUNTY OF -�[ .k
Sworn to(or affirmed)ano subscribed before me of Physical Presence or Online Notarization
this I#- day of gallfigr 20%1 by
Name of person making statement
Personally Known % OR Produced Identification
Type of�- C`on
Produced
(Signature of Notary, fic-State
CHRISTINE JOYCE CONWELL
Commission No.
( Notary Public•State of Fiorl4a
Commission K GG 4i4701
My Comm.Expires Aua 21,2014
Bonded through National Natery Assn;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
GATT
COMPLETED
ev 5/20/2