HomeMy WebLinkAboutMeenan AC Change out permit app pg 2SUPPLEMENTAL CO~IJBVt.AWfNfORfMTION: ··. ·• .
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DESIGN_T EER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPLE Trn.E 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 worlc 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 ~talion that is grantin11 a penpit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeown""' "5sociation rules, bylaws or and covenants that n:,ay restrict or prohibit such
structure. Please consult with your Homeowners Association and revtew your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I wiR, in aH respects, perform the worlc
in aaordance with the approved plans, the Rorida Building Codes and St. Lucie County Amendments.
The following building permit applieations are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools. fences, walls, signs, saeen rooms and accessory uses to another non-residential use
WARMNG TO OWNER: Your failure 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 recon:ls of St.
Lucie Courtty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
ithl d befo . k d" N . ofCo w en er or an attomev re commenan11 wor or recor mf! vour otice mrnencement.
~ ~ i!"-1'~
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA St.woe, COUNlYOF
Sworn to (or affirmed) and subsaibed before me of ✓ Physical Presence or __ Online Notarization
this:i,.µi.-day of :r~ . 20 zi-by
Mitfu8£1 £ ~
Name of person makingment.
Personally Known ✓ OR Produced Identification --Ty~ Identification Produ,.....
{U, 'J);irJ;,;,; / /1,--•nJ~/./_ -.,
(Signature of N mteGliNIWfdi)'CE CONWELL
(; Notary Public• Stat• of Florldl
Commission No. ----i
.. uton I GG 98 ◄701
,,, . .,. ·· Exptrts Av1 21, 2024
··· '""aondfd throu1h M1tion1l Notary Aon.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURnE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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