HomeMy WebLinkAboutSoldano AC Change out permit app pg 2SUPPLEMENTAL CONSTRUCllON UEN lAWIN~TION:
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DESIGNER/ENGINEER: -Not Applicable MORTGAGE COMPANY: _ Not Applicable .
Name: ________________ _ Name: _______________ _
Address: __________ c------
Oty: ____ --,-_____ State:
Zip: _____ Phone. _________ _
Address: _________ ---=-,----
Oty: ____ =-------·State:
Zip: ____ Phone: ________ _
FEE SIMPLE TinE HOlPER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Address_: _______________ _ Name: ______________ _
Address: _______________ _
City: _____ -,-__________ _
Zip: _____ Phone: ________ _
City: -----------------Zip: _____ Phone: _________ _
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the -and kistallation 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 pe1111it will authorize the permit hokier to build the subjeg structure
which conflicts with any apP!iC3ble Homeowners Associalion rules, bylaws or and covenants that may restrict or prolumt such
structure. Please consult with your Homeowners Association and revoew yourdeed for any H!Sbictions whim may apply.
In consideration of the granting of this requested pennit,, 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 uodagomg a full concum,ncy 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 ComrMncement 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 atto...,,,,, before commencinl! work or recordinl! vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATEOFFl.ORIDA S\-. r Hr;,,
COUNTYOF ____ ~-~~~-----
%hysical Presence or __ Online Notarization Sworn to (or affirmed) and subsaibed before me of
this~dayofn«'41!'1bt,r • 2D);!_by
M fcLiw £ Bo:/t.;,
Name of person making t.
Personally Known ✓ OR Produced Identification
Type of Identification Produced. _________ _
~~fl~at (SignatureofNota~ State . a) .
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