HomeMy WebLinkAboutPotter AC Change out permit app pg 2 SUPPLEMENTAL CANST[UC rON UEN LAW INFORMATION:
N:
DESIGNER/ENGINEER: ! Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Nat 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.
1 certify that na work or installation has commenced prior to the issuance of a permit.
w Lucie County makes nor presentation that is®ranapermit will authorize the permit holder to build the subject structure
which conflicts with any app cable homeowners AAsss n 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,t do hereby agree that 1 will,in all inspects,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 non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Convnencement may result in payiag 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 attorney before commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA '
COUNTY OF - Luck,
Sworn to for affirmed)and subscribed before me of r' Physical Presence or Online Notarization
this IL4t day of 1 fry aryl ,201Z by
Name of person making statement
Personally Known OR Produced Identification
Type of identification Produced
(Signature of
r C14RISTINE JOYCE CONWEtL
Commission 11 Notuy to Of FWds
Son
1.9mmTH on 9W01
orris:•' My Comm.Expires Aug 21,2024
MAW thr0%h Netiw4J NOIry Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED