HomeMy WebLinkAboutBergeron AC Change out permit app pg 2.pdfSUPPLEMOOALCONSTI\UCTIOffUfNLAW~llON:
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DESIGNER/ENGINEER: _ Not AppHcable MORTGAGE COMPANY: _ Not Applicable Name: ________________ _ Name: _______________ _
Address: ______________ _ Address: ----------------City: State: ------,=-------Zip: _____ Phone" _________ _
0 ty: ___________ ~State:
Zip: _____ Phone: _________ _
FEE SIMPU: TinE HOlDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: ________________ _ Name: ______________ _
Address: ______________ _ Address: ----------------Oty: ____ -=-----------Zip: _____ Phone: ________ _
City: _____________ _
Zip: _____ Phone: _________ _
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the won< and installation as indicated.
I certify that no wori< or instaRation has commenced prior to the issuance of a permit.
St. Lucie County makes no ~tion that is granti!'& a perl!'llt will authorize the permit holder to build the su~ structure
which conflicts with any apJl!tcable Homeowners ASsocialion rules. bylaws or and covenants that m.av restrict or prohibit such
structure. Please consult with your Homeowners Association and n?Yff!W your deed for any restrictions which may apply.
In consideration of the grantlng of this requested permit, I do hereby agree that I will, In all respects, perform the work
in accordance with the appr<M!d plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
acce5S01Y structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-<esidential use
WARNING TO OWNER: Your failure to Remrd a NOlic:e of Caoaniencen-t may ,-min 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 commencin11: work or recordine vour Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner
STATEOfFLORIDA ~L_ J ,,,.;,.
COUN1Y OF ____ Jr __ ~~~-----✓ Physical Presence or __ Online Notarization Sworn to (or affirmed) and subscribed before me of
this~ day of feba~ , 20 ~ by
~a~!flrson ~~~Lnt.
Personally Known ✓ OR Produced Identification
Type of Identification Produced.-,,. ________ _
/1_,h: ~,.-:, Q_ /~ --, . '.UL-
(Signature of Notary "'...,.,._ ,.,,,.
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
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I ,•i->!b...;;,;""" CHAISTINE JOYCE CO""'fLL· "
il{•~Y.:\ {Siellli, Public· Stltl of Florid<
!'i.~,#! Comml,slon #GG 91 ◄701
'"'?.f~i My Comm, Explr.,Aut 2). 20l ◄
'"""""' Sooded throueh Notion■! Notiry W,
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURRE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW