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Project Name:
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all that apply:
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APR-28-2017 FRI 02:06 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003
t
IMP
M@I I - 11 IN low 1 -ON
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
'WLucleCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
chisincon conflict with any applicable Homeowners Association rules,bylaws or and covenants that may.restrict or prohibit such
w 1% 2
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 falloVing building permit applications are exempt-from UndergQ]n'g 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 your Notice of Commencement.
Signature of winerl Agn�/LL see
TV I
Signature of wner/Agent/l. see Signature of Co ctor License Holder
STATE FLORIDA STATE OF FLORID�
COUNTY OF COUNTY OF
The oinginstge!n�twi3-iacknDwledge DeFore-me The ging instru ent Was acknowledged before me
thisl�g day of I I this!�(k ay of MY-1 by
fie. • 1-�
20!wby
(Name c person acknowledging)-- (Name of person acknowledging)
ti
(Signature of Notary Public-5tiAeIorida). (Signature of Notary Public-State of
Personally Known OR Produced Identification Personally Known_X_oil Produced Identification
.Type of Identification Produced Type of Identification Produced
commission No'if # ealpathne X01gocommlssion No,
SAS;, r.,commission 172312 Catherine Kwigee
n
BONDEDTHW
PLevised.07/15/2014
eetNt`� QST HUNDEDT11
FLORIDAN
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE '
COMPLETE
INITIALS