HomeMy WebLinkAboutSt George ac change out permit app pg 2.pdfSUPPLEMENTAL CONSTRUCTION UEN I.AW INFORMATION!
DESKiNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: --Qty: 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 woric: 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 representation that is granting a pell!lit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Jlssocialion 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 conwrrency 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 Reoal'CI a Notice of Commencement may result in 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 attorney before commencing work or recording vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 5\-. wcie.. COUNTYOF
Sworn to (or affirmed) and subscribed before me of ~hysical Presence or __ Online Notarization
this ~day of f?Joruoet . 20.Y:_ by
M.1c~atJ ~. ~
Name of person maki11g;;ment.
Personally Known ✓ OR Produced Identification --Type of Identification Produced
() Afl:~""' Cl C~ --,,,,, /~ -
(Signature of No ,...._. o. •111---'-Y,-,,,t.D, .......
' ~~ CHRISTINE JOYCE CONWELL Commission No.1 Ki] ·, "···· fflmll Sutt~, Flond,
1 Commission # GG 93~·701
I ~,~.~' My Comm. E.xptrtsAu171~ 2024
Bondtd thrOIJtl, National Nollry' --
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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