HomeMy WebLinkAboutShaddock pg 2.pdfSUPPI.EMENTALCONSIRUCHONI.IENlAWtNmRMAllONr·
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DESIGNER/ENGINEER: -Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
Oty: State: Oty: State: ----Zip: Phone Zip: Phone:
FEE SIMPLE TITlE HOlDER: _ Not Applicable BONDING COMPANY: _Nqt Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIOVff: Application is hereby made to obtain a pem,it to do the work and installation as indicated.
f certify that no work or instaUation has commenced prior to the issuance of a permit.
St. Lucie County makes no ~sentation that is granting a permit will authorize the permit holder to build the sub~ structure
which conflicts with any apP.!1cable Homeowners Association rules, bylaws or and covenants that 11_1i1Y restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions whicl, 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 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, saeen 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 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 attomou before commencing work or recordini, vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA St. l.Ltde.. COUNTYOF
S~ (or affirmed) and subscribed before me of
thi _ day of Ma,dl . 2<U-by
%hysical Presence or Online Notarization -----
M~~ir.eJ f. ~
Name of person maki;:;; ment.
Personally Known ✓ OR Produced Identification --
Type"' i:~tification Produced ("_, ~ 0,. /. --· ,,,/t7
(Signature of Nata"' .el!Ml~CE CONWELL
: ~ ~) Notary P\J.b!ic • Stat• of Florida
Commission No._ 'j ~1on I GG 9a•101
........... / .. , om • Explr,s Au1 21, 2024
iondtd throUjh N1tlonal Notlry MSn.
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev :,u.ut-i:J.