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FEB-02-2017 THU 12 13 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: . Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: "
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:_ _ Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St:l.�cie Count makes no representation that is granting a permit will authorize the permit holder to build the subject 5 cture
whit is in con Ict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or pro ,bit 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 I will,In all respects,perform the work
In accordance with the approved plans,the Klorida 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,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
Signature f 0r/Lessee/Contractor as Agent for owner Signature?f Contra r/License Holder
STATE OF FLORIDA PJ1 STATE OF FLORIDA
COUNTY OF V� i� COUNTY OF C �
The forgoing instru t w s acknowledged before me The forgoing instrument was acknowledged before me
this i day of 20 by this day of ��Q'A420 :1 by
-;�Jqe d rro-11Pr
-- eor -
(Name of person acknowledging) (Name of person acknowledging)
I �
(Signature of Notary Public-Stof Florida) (Signature of Notary Public-Stdtk of Florida)
Personally KnownQR Produced identification Personally Known_OR Produced Identlficatlon
Type of Identification Produced r I Type of Identification Produced .CJI
�Cb7i r r' r
- Comm{ssion#RP172 = omission#FF17237a
Commission No. �J� - e elms OCT 28,2
mmission No - ,'_� fres:QCT 20,x018
e0N BO THRU
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS