HomeMy WebLinkAboutTheriault ac change out permit app pg 2.pdfSUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATION:
DfSl6NfR/fNGINEER: _ Not Applicable MORTGAGE COMPANY: -Not Applicable
Name: Name:
Address: Address:
City: State: --Qty: State: --Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOWER: _ 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 wori< 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 ~ntation that is granting a pen)'lit will authorize the permit holder to build the subject structure
which conflicts with any apJ>hcable 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, l do hereby agree that I will, in all respects, perform the work
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 review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non~ential use
WARNING TO OWNER: Your failW'e to Record 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
"th I d bef . k d" N . of Com WI en er or an attomev ore commenttnl! wor or recor tnl! vour otice mencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA St.Lucie., COUNlYOF
Swo,:n to (or affirmed) and subscribed before me of /physical Presence or __ Online Notarization
this/I~ day of M~ 20.ii. by
MfdjteJ ~ ~
Name of person rnakingement.
Personally Known ✓ OR Produced Identification --Type of Identification Produced ·r1.h~ ( //,-~ -~
~ V
(Signature of Notary Public fl tate of Florida)
Commission No. ,c'i,>.U.;;\ CHRI .. YCtCONW!tL
i• -~-•1 .. .,_,, ublk • Sl1tf.Qf Florida \J ~ · Commf,sloo I GG 9&1701
I
·• ........ P:i/ My Comm. E,q,1,., Au1 Jt, 202<
Bondf<I thrOUjh Nation,! Notary AHO,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TIJRTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECENED
DATE
COMPLETED
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