HomeMy WebLinkAboutWelch ac change out permit app pg 2 SUPPLEMENTAL CANST UMON LIEN LAW INFORMATM:
DESIGNERIENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Prone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFIFIDVIT:Application is hereby made to Main a permit to do the worts and installation as indicated.
I certify that no work or instattation has commenced prior to the issuance of a permit
St, Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any appltrable Homeowners Assooa3ian rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consul with your Homeowners Association and review your deed for any restrictions wNch 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 plants,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing,a full wncurrency 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 NaRiae 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.tf you intend to obtain financing,consult
with lender or an attomey before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLCHUDA
COUNTY OF �[.
S (or affirmed}and subscribed before me of Ntysi al Presence or Ordine Notarization
this day of 1.CLVr4l 20,by
.kafiel E.
Name of person making statement.
ment.
Personally known V/ OR Produced Identification
Type of Identification Produced
(Signature of Notary P - tate of Flo da)ri
'ice ., CH TINE JOYCE CONWELL
Commission No. Public-5tite q(FlarfEe
j� MY Commission 0 GG�E1701
MyComm.Expires AV: 21,2024
Sorded through Mationel aotary AW.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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