HomeMy WebLinkAboutCloutier AC Change out permit app pg 2j ���crr sur►M
Name: � T
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE MOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: � Not Applicable -
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
city:
Zip: Phone -
OWNER/ CONTRACTOR AFRDVIT: Application is hereby made to obtain a permit to do the work and installation as iri ated.
I certify that no worts or installation has commenced prior to the issuance of a permit
St. Lucie County makes no representation than is fin ? permit cribl authorize the permit holder to build the subject structure
which carrfilcts with mop ie Homeowners rules, bylaws or and covenaarts that may restrict or prohibit such
structure. Please rorrscrit r Flarr►eurners Association and review your deed far arty restrictions whit!, may apply.
In consklerabion of the granting of this requested permit, ! do hereby agree that I wilt, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie Cour ty Amendments_
The followving building permit applications are exempt from undergoing 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 f lure to Record a Notice of urlierlicerrwrit may result in paying thrice 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 tender or an attorney before c:ommencinla work or recordinix your Notice of Commencement
_ X
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF
Sworn to (or affirmed) and subscribed before me of Y Physical Presence or Online notarization
this I SP day of 201-?- by
Nam o#person malting sbiternent
Personally known OR Produced Identification
Type of bdentification Produced
(Signature of Rota
CHRISTINE JOYCE CONWELL
Commission No. ;P; tour tplic • State of Florida
Commission p GG 484701
My Comm. Expires Aug 21, 2024
Bonded through National Notary Assn.
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