HomeMy WebLinkAboutW Bouchard ac change out permit app pg 2SUPPLEMENTAl:.CONSTRUC110r,tl.lE81AWINFORMATION:··
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPLE TITI.£ HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Appficatiot, 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 ~tion that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any apfl!icable Homeowner.; 1'ssociation rules, bylaws or and covenants that ~ restriCt or prohibit such
structure. Please consult with your Homeowners Association and rev,ew your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1-, in aH respects, perform the wori<
in accordance with the approved plans, the Aorida Building Codes and St. Lucie County Amendments.
The following building pen-nit applications are """"'Pt from unde,going 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 faihn-e to Recotd a Notice of Commencement may result in paying twice fw
improvements to your property. A Notke 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 commennna work or recoroine: your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE Of FLORIDA <:-L_ r ,.,;,.
COUNlYOF ____ JI_;_~~~-----✓ Physical Presence or __ Online Notamation Sworn to (or affirmed) and subsaibed before me of
this/2t:.dayof . 20_by
M,d,w E. ~
Name of person making
Personally Known ✓ OR Produced Identification __
Type of Identification Produced-,,,.. ________ _
17./~;.,,.,t -~ n r1. _,, //..
(Signature of Nota..,,.,. bl~-State of Florida)
Commission w;i,m• .... ; .............. , CHRISTINE J~~NWEl_L
I 7~f".~ ·, ,ietat 1 Pablk • )tirf'of Florida '·i f! Commission I GG 91<701
• ............................. / My Comm. ExplrttAVI 21, 202•
londtd <htov1h N1~on,1 Not1ry Assn.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
'(eV.... •
FRONT ZONING
COUNTER REVIEW
SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW