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Y.t•::,::::::•::::»v ,rt{v: nt•: n,•>:::.:.»• Name PAUL BERGERON Name: DAVID SMITH Address: 1097 SEMINOLE DR Company: ONE CALL AIR CONDITIONING City: FORT PIERCE FL State: Address: 968 SW PROVINCETOWN LN Zip Code: 34982 Fax: City: PORT ST LUCIE State: FL Phone No. 772-971-1427 Zip Code: 34953 Fax: E-Mail: Phone No 772-201-3885 Fill in fee simple Title Holder on next page ( if different E-Mail ONECALLCOOLING@GMAIL.COM from the Owner listed above)-) State or County License CAC1817403 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. ONE Not Applicable MORTGAGE COMPANY: Not Applicable DESIGNER/ENGINEER: Name: Name : Address:- Ad d re !ss: 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: Phone: 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 h8s.commenced prior to the issuance of a permit St.. Lucie County makes no representation sentation that is granting.a permit will authorize the permit holder to build the subject structure which conflicts with anapplicable Homeowners Association 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 work in accordance with the approved 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, accessory structures, swimming pools, fences, walls, signs, screen rooms and -accessory uses to another n.on-residential use WARNING TO OWNER: Your failure to Record allotice of Commencement may result in paying twice for improvements mprovements to your property: perty. 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 o'btain financing, consult with lender or an -attonev betore commencinfz work or recording vour Notice of (-Ommencement. 6ature of Ownerl Le'ssee/C"6ntractor as Agent for Owner STATE OF FLORIDA COUNTY OF Sworn to (or affirmed and subscribed before me of this l day of 20 by Physical Presence or Online Notarization Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced Fla a A,00 Ld 156Z (Signature of Notary. Public- State of ida) 7H EATH E.R'BUR FORD Commission No. (Seal), State. of Florida -Notary Pu blic b lic Commission # GG 183217 ]D �J M s NN :,. Y commission expires Mill %NN February 06, 2022 wo REVIEWS FRONT ZONING SUPERVISOR. PLANS VEGETATION SEA TURTLE MANGROVE. COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVII EW DATE RECEIVED DATE COMPLETED Rev 5/20/2