HomeMy WebLinkAboutHoude AC Change out permit app pg 2SUPPLEMENlAL CONSTRUCTION UEN I.AW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: _________________ _
Address:-----------,,------City: _____ -.-______ State:
Zip: _____ Phone _________ _
Name: Addres-s: ______________ _
City: State: ---------,,.,--------~ Zip: _____ Phone: __________ _
FEE SIMPLE TITLE 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 fnstalfatiOn as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no reyresentatiOn that is granting a perrJlit will authorize the permit holder to build the subitlct structure
which conflicts with any apJl!icable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wtth 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 Buttding 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: Yow faHure 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 attomev before commencinl! work or recordina vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA <:-L r ,,,.;
COUNTY OF ___ .JC....;..;....c. l-l,\l,l'--""--(!_,----
%hysical Presence or __ Online Notarization Sworn to (or affirmed) and subscribed before me of
this~dayof t,,{&yt,nbU-,202.1 by
MfrL,a,J f: ~
Name of person maki/4iefflent.
Personally Known ✓ OR Produced Identification
Type of Identification Produced.~~--------() /4, · -~I l, ~
(Signature of Notary PUP,1--State of Florida) -
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev ..
.A~ !ii.;-.._ ~TIME JO~E CONWELL ;.,f! ; 1/o~liubHc • S\att of Florida
\ij t,'J) Comml,slon UG 91◄701 '··-!.l "i..--' My Comm, Explrtt l.ut 21, lOl•
"" Bondoc! throu1h N,tlonal ~•ry Alsn.
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
MANGROVE
REVIEW