HomeMy WebLinkAboutCole AC Change out permit app pg 2SUPPL~MENTAl CONSrRUCTION UEN IAW INFORMATION: --,' .
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: _________________ _
Address: ------------,,------City: ____________ State: __
Zip: _____ Phone ________ _
Name: Address_: ______________ _
Oty: -----.--------'State: __
Zip: Phone: ----------------
FEE SIMPLE TITLE HOWER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Addres-s: _______________ _ Name: _______________ _
Address: ________________ _
Oty: -----=-------------2 i p: _____ Phone: _________ _
City: _______________ _
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 perl!lit will authorize the permit holder to build the subject structure
which conflicts with any appficable Homeowners Jlssociation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and A!VH!W 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 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 Record a Notice of Commencement 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 attornev before commencim! work or recordinl! vour Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORIDA <:::-L_ I,.,.;,.
COUNTYOF ____ Jl:-'---'~-=-------
%hysical Presence or __ Online Notarization Sworn to (or affirmed) and subscribed before me of
this 121=_ day of ijav,,ft'.)btY-, 20 2,1 by
~a~!!L t;ak~£iL1.
Personally Known ✓ OR Produced Identification __
Type ~tle,?tification Produced
LiAt~, i· ~14 (Signature of N-ry Pu~ ~•a~ ·
Commission No. ii, Noi.ry Pcbllc • 1111• of Flondi
,-,,mi!·~•··•... CH~ISTINE JOYCE COMW!LL
, ._, i Commlnlon # GG 91◄ 701
REVIEWS
DATE
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DATE
COMPLETED
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· \~i::r~ ... / My Comm. ExplrflAUt 21, 2024
. 8olidod thrO<llh National Notary .... '
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION SEA TURRE
REVIEW REVIEW REVIEW REVIEW
MANGROVE
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