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FEB-01-2017 WED 01 23 PM CENTRAL SCHEDULING FAX No. 321;28$613$ P, 003/004
rih
§ 'T
PDMESl6NERIENGINEER: Not Applicable MORTGAGE COMPANY: „Not Applicable
Name: Name:
Address: Address-
City: State: _ City: State:
Zip: Phone: Zip:_-- Phone:
PEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: `Not Applicable
Name: Name:
Address: Address:
City: city:
Zip: Phone: Tp: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
st,l ucle county makes no representation that is granting a ppermIt will authorize the permit holder to build,thgsubidct structure
which is in conflict with any applicable Home 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 t will,In ail respects,perform the work
in accordance with the approved plans,the Florida Building Codes and 5t.Lucle County Amendments.
The following building permit applications are exemptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to anothernon-residential use
WARNING TO OWNER:Your fallureto Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and pasted on the jobsite
before the first inspection. If you Intend to obtain financing,consult with lender or an attorney before
cornmencin work or recording our Notice of Commencement.
Signatur of Ow r/Agent/Lessee Signature Con ctor/License Bolder
STATE OF FLORIDA' STATE OF FLORIDA
COUNTY CiF__ r
COUNTY OF
The fgrgoing inst ant was acknowledge{before me The forgoing instr ' ent was acknowledg efore me
this_]�._da of zo J this V day of ,2a by
{Name of-person acknowledging) (Name of person acknowledging)
CI
{Signature of Notary Public-State F rids} (Signature of Notary Public-Sta orida)
Personally Known , OR Produced Identification Personally Knowri`l OR Produced Identification
Type ofidentlfication Produced Type of Identification Produced
, �Conustan#FF17237r �"'-, Cathefte Dngr
t _ 2Ire :OC188,�01mmssvNo,' F1372Commssion No-
•,•,� aoNDHp Ttrntr =ExptrEs:OCT 28,zole
1;;,, •`
1sTp1AR?PANDrAAxLL : $ONdHATHAU
Revised 07/151201.4 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW 'REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i