HomeMy WebLinkAboutShiflet AC Change out permit app pg 2SUPPLEMENTAl~Ur:NlAW~:. '
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
Oty: State: --City: State: --Zip: Phone Zip: Phone:
FEE SIMPLE Tl11£ HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
Oty: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Appl"ication 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 rel)n!S!!ntation that is t!rantin& a pe<IJlit will authorize the permit holder to build the subiect structure
which conflicts With any applicable Homeowners Associalioil rules, bylaws or and covenants that n,ay restnct 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 wm, in all respects, perform the worlc
in accordance with the approved plans, the Aorida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency ...,.;.,w; room additions,
accessory structures, SWimming pools, fences, walls, signs, screen rooms and accessory uses to another non~idential use
WARNING TO OWNER: Yaw failure to Record a Notice of Commencement may result in pavtng 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 commencimi work or recordine vnur Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORIDA <:'L I,,,.;
COUNTYOF ___ JI~-~i,.v.u-=·~----
✓ Physical Presence or __ Online Notarization SwOJll tp (or affi"l)e!I) and subscribed before me of
this;c.d,,,.dayot.f._t.bm~ ,20~by
~~g;Jmak~il!ment.
Personally Known ✓ OR Produced ldentilication __
Type of Identification Produced _________ _ ~&.&;;~
(Signature of Notary P.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
FRONT ZONING
COUNTER REVIEW
SUPERVISOR PlANS VEGETATIOH SEA TURTlE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW