HomeMy WebLinkAboutMurphy AC Change out permit app pg 2.pdfSUPPLEMENTALCONSTRtJCTJONUEN tAWINFORMAU:
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DESIGNER/ENGINEER: _ Not.Applicable MORTGAGE COMPANY: _ Not Applicable Name: _________________ _
Address: __________ c------
City: _____ .,-_____ State:
Zip: _____ Phone _________ _
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Address_: ______________ _
City: -------ccc-------------Zip: _____ Phone: ________ _
Name: Address_: ______________ _
City: -------,---------'State: Zip: ____ Phone: ________ _
BONDING COMPANY: _Not Applicable
Name: _______________ _
Address: ________________ _
City: ______________ _
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 has commenced prior to the issuance of a pennit.
St. Lucie County makes no ~resentation that is granting a petl!lit will authorize the permit holder to build the subject structure
which conflicts with any apjlltcable Homeowners Jl.ssotiation 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 Aorida BuUding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming poofs, fences, walls, signs, saeen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Ream! a Notice of ~,t 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 attomev before comrnencinR work or recordine: vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA <::-L I ,. ,.;
COUNTYOF ___ .Jl:-'--·._i,.v.u--=_e, ___ _
%hysical Presence or __ Online Notarization Sworn to (or affi'l'!edl and subscribed before me of
this~day of ~Qi\ • 2014-by
~a~!fi.on ~k~l{~ment.
Personally Known ✓ OR Produced Identification
~ J tlrm,»Ld (Signature of Notary Publ-iate
Commissi-. ....~,;~ CHRlffiH! Je WELL
{fm,\ MotartPLiblic · Stattof ~lorida \\,\AJ./f Commiuion # GG 98◄701
\";?)O#r,.~/ My Comm. ExplrtsAUj 21, 2024
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