HomeMy WebLinkAboutGould AC Change out permit app pg 2 DESIGNERANGINEER., Not Applicable lIIKlRTGAGE COMPANY: Nat Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _,.Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Mimi : Zip: Phone-
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and irtstallation as indicated.
I ca ify that no work or installation has commenced prior to the Lssuance of a permit
St.Lucie County makes no representation that is gran a permit will authorize the permit holder to build the subject structure
which conflicts with arty applicable Homeowners Assaczon rules.bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for 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 worts
in accordance with the approved plans,the Rodda Building Codes and St Lucie County Amendments.
The following building permit applications are exempt frorn undergoing a full eoncurrency review:room additions,
accessary structures,swimming pools,fences,walls,signs,screen roorns and accessory cases tD another non-residential use
WARNING TO OWNER:*Tmw face to Roane d a Notice of nwV result in paying twice fior
improvements to your property.A Notice of Comnxmcemerit 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 tender or an attorne before commencing work or recording r Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 5�_
COUNTY OF
Sworn to(or affiumed)and subscribed before me of mysical Presence or Online Notmixation
this �✓day of 20�2 by
"O f. &VIL
Name of person making t
/ errren
Personally Known y OR Produced Identification
Type of Identification Produced
(Signature of State of Horlda)
�...,... t�su OYCE:Of"NorWa
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Commission Ho. � •.
+� SUCvm"Slon 1 GGMy Comm,bPfm A!lond#d thrau�h N+tlontf ran.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTF_R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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