HomeMy WebLinkAboutLalonde AC permit change out app pg 2SUPPLEMENTAL CONSTRUaIONUl:NI.AW UIIFORMlfflON: . .
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OESIGNER/ENGINHR: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
aty: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPl.E Tl11E 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 ~ntation that is ~will authorize the permit holderto build the sub.i<1g structure
which conflicts ~ applicable Homeowners · · rules, bylaws or and covenants that n,ay restrict or prohibit such
structure. Please with your Homeowners Association and nMeW yourdeed to, 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 Aorida Building Codes and St. Lucie County Amendments.
The following building permit applications are aempt from undegoing a full concurrancy 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 Ret:lofd a Notice af Commeiicement 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 commencinR: work or recordine vour Notice of Commencement.
,m;J.-./:;,~~~
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF RORIOA St l..uck, COUNTYOF
Sworn to {or affirmed) and subscribed before me of
this~ day of ~r.,v:im.be.C . 20~ bv
✓ Physic.al Presence or __ Online Notarization
M1c~,eJ £ ~
Name of person mal<ingnent.
Personally Known ✓ OR Produced Identification --Type of I entification Produced
f' J ,, ff,_·, C ... IJn,w.uL
(Signature of Notary "r, ic-' ~e~
l~~,·· '•,. CHRISTINE JOYCE CONWELL
Commission No. !~• .) Notary Public· Stitt of Florida
. \ fl/ Commission II GG 9&◄701
'•,, f\i,·· • My Comm. Explr•s A.u121, 202 ◄
' ........ Bonded thr""lh N1ttonol Notary-·
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TlJRilE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETEO
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