HomeMy WebLinkAboutLake AC Change out permit app pg 2.pdfSUPf>l,a49¥fAl~-itAW~-:·· -
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: ________________ _ Name: _______________ _
Address: ______________ _
City: ___________ State: __
Zlp: _____ Phone. _________ _
Address=-----------=----
City: -----.--------'State: __ Zip: ____ Phone: ________ _
FEE SIMPLE TITLE HOlDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: ________________ _ Name: ______________ _
Address: ______________ _ Address: _______________ _
City=------=-----------Zip: _____ Phone: ________ _
City: ___________ _
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 comrne,iced prior to the issuance of a permit.
St. Lucie County makes no ~tion that is granting_a perl!litwiU authorize the pen-nit hold...-to build the sub~ structure
which conflicts with any apP!•cable Homeowners J\ssociation ru~ bylaws or and covenants that n_iay restrict or prohibit such
structull!. Please conSUlt with your Homeowners Association and -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 aU respects, perform the worf<
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications all! exempt from undergoing a full COIICllm!flcy review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another llOfHesidential use
WARNING TO OWNER: Your failure to Remnl a Nodclll of Coc-.cement 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 commencimz work or recordine vour Notice of Commencement.
Slgnatull! of OWner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA <:L. I,,,.;,,
COUNTYOF _____ Jt_~~~-----✓Physical Presence or __ Online Notarization Sworn to (or affirm~) and subscribed before me ol
this~dav of ytllffl Mv;y . 20 t.i-bv
M frU4PJ £ BoJJt
Name of person making ent.
P"™>!lally Known ✓ OR Produced Identification __
Type of Identification Produ,r'?r.!'----,.,,•-------~ lA (/;,-·•·dJ--
(Signatull! of N
_,._@· i.;.,. CHRISTIN! .foYCf CO>IW!LL
Commission No.. {f,F'",, ~~'1 N(N~_b!i( • Stitt of F.lorldl -fl•, !t ; 'C'omml,slon IGG9B•1Q1
REVIEWS
DATE
RECEIVED
DATE
COMPLETED .. ev_, __ , __
·-,,., _./ My Comm. Expire, /.Uf 21. 102..-
iondt<I throUfh National Not1ry .\sin.
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURUE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW