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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.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 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 I 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 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.
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nature of Owner/Lessee/Agent ature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
+-
COUNTY OF • ���'' COUNTY OF Pa1�t
The for ing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this q day of YYt�y` 20 11 by this day of M A� 20 by
(Name of person acknowledging) (Name of person acknow edging)
W
(Signature Notary Public- tae of Florida) (Signat a of Notary Public tate of Florida)
Personal) Known �R Produced Identification Personally Known 4' OR Produced Identification
Y
Type of Identification ro lie s;" 0 Type of Identification Produced
;$ o�A� a"`n ANGELAYOUNG
Commis on# F 051484 Commission No. K1Y COMMf09 FF 951069
Commission No. Expires ber5,2017
BodedTWUimyFah 4nsuroneueo� W7019 N9.',� \oma EXPIRES:Apol12.2020
rF cO¢ d: Th ^' .
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS