HomeMy WebLinkAboutKurzrock AC Change out permit app pg 2.
SUPPLEMENTAL CONSTRUCTIOl'fl.lEl',l U\W SNFORMATIOlt: .
D£SIGNER/ENGIN£ER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
Crty: State: --Oty: State: --Zip: Phone Zip: Phone:
FEE SIMPLE 1J11.E HOLDER: _ Not Applicable 80NDINGCOMPANY: _Not Applicable
Name: Name:
Address: Address:
Oty: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTORAFFR>Yrr: AppliGation ishen,b\, made to obtain a permit to dothe••<>rl<and installation as indicated.
I a,rtify that no won: or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no repn!S!'nlation that is granting a pen!)it-authorize the permit holder to build the su~ structure
which conflicts with any aPfJ!lcable Homeowners Association rule$, bylaws or and covenants !hat may restrict or prohibit such
structure.PleaseainsultwilhY<JUl"ltum1:ow11eisASlillCiationandrevt1:Wyourdeedforanyrestrictionswhichmayapply.
In consideration of the granting of this requested pennit, I do heR!by agree that I will. in all respects. perform the wori<
in accordance with the approved plans. the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are e,iempt from u1tdaguir,g a full aincurrency rev-= room addi-.s,
accessory structures, swimming pools, fences. Willls, signs, saeen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Recorda Notice of Co.1Nue..c:e,_ may r-.lt 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
ith I nde be1i . orlc di N . of Com w e r or an attomPV ore commenano w orrecor ne:vn11r otice mencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF R.ORIDA St. wcie,. COUNTY OF ✓ Physical Presence or __ Online Notarization Sworn to (or affirmed) and subscribed before me of
this~ day of l,J 11vR m bf C • 20.1.!_ by
Mk~iJ [ ~
Name of person mal<ingcbt<..,.ent.
Personally Known ✓ OR Produced Identification --
Typ? 2~ntification Produced IZ // :,m-~ /J &,«/ .tU-
(Signature of Notary~-State of Aorida) • ,1~ •·····... CHRISTINE JOYc,E CONWELL ffw"\ Notary Public· S~• of Florido I
Commission No. (Seal) i 1 ~; Commission # GG 984701
\ .. , .. ,~ .. -/ My Comm, Expir.sA1,1g 21, 20H
·· ·· · Bondtd thrOUlh National Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW R£VlEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
\ev~ • ..