HomeMy WebLinkAboutWindmill Village - Bath House Pedestal Replacement Page 2SUPPLEMENTAL CON.STRWrl.Q- 1; Eft LAW WrMMATIOM
DESIGNER/ENGINEER: Not
Name:_
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: TNot Applicable
Name:
Address:
City: ------
Zip: Phone:
vvvI-ecru/ 9-um I KIAS— I UK AtMUIVII I : 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 permit_
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Dome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 1 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 concurraency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice fo —
improvements to your property_ A Notice of Commencement must be recorded in the public r or
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financ ng,
with lender or an attorneybefore commencing work or recording your Notice of CommencemP t.
Signature of Owner/ Vssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFti
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this I day of 2020 by
&0� jz�
Signature of Contra or/License Holder U o y
rbM
•y -0
STATE OF FLORIDA 2 .E .
COUNTYOF tAQY-4-1Y-\ i� o
Sworn to (or affirmed) and subscribed before me
-,X—Physical Presence or Online Notariza
this -2-C� day of 2020 by
Dame of person making statement_ Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
1 JINIAL 7. SUSAN SLACK
(Signature of Notary Publi R )gF�bk - state of Y,orida
4 Carrmissior. x CG 301352
My �cmm Expires Mar 5, 2023
Commission No. G — 3onded t401ationa! Notary Assn.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
Personally Known OR Produced Identification
Type of Identification
Produced hL-
(SkQLtu,k of Notary Public- Sta of Florida )
Commission No 3 (Seal)
SUPERVISOR I
PLANS I REVIEW VEGETATION
S REVIEW REVIEW