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VP/annfng and Development Services
-80dfng and Cade Regulotlon Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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0 PERMIT APPLICATION FOR
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DESIGNER/ENGINEER:
Name:
Address:
City:
Zip.
Phone:
FEE SIMPLE TITLE HOLDER.
Name:
�- Address:
City:
Zip:s
Phone:
x Not Applicable
State:
x Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY,
Name:
Address
City:
Zip:
Phone:
x Not Applicable
State:
Not Applicable
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 Horne Owners Association rules bylaws or and covenants that
p , Y may restrict Or prohibit such
structure. Please consult with your dome 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 your Nonce of Commencement.
- Mature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �T A A. C.._ IV.:
The for oing instrument was acknowledged before me
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this 01 day of i�.J�•. 20 A 7 by
M v:- C -'I
(Name of person acknowledging)
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Signature of Notary Public- State of Floridl
Personally Knowq OR Produced Identification
Type of Identification rA MOONS
\.\, SUSAN NTENEGRO
Commission No. My COI # GG 089D'99
y� :� PI ES44 Npd f 2021
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Revised 07/15/2014
REVIEWS
DATE
COMPLETE
INITIALS
11 1 1 1 1 • i
FRONT
COUNTER
ZONING
REVIEW
ture of Contractor/License Holder
STATE of FLORIDA
COUNTY OF -.
The forgoing instrument was acknowledged before me
this `I, day of h 1 , 20 (�7 by
(Name of person acknowledging)
r
Signature of Notary Public- state of Plorida�
Personally Known OR Produced identification
y Type of Identificaion Produced
Commission No. SUSAN WONTQNEGRO
My COMMISSION # GG 089099
.�; EXP I RE A0 2, 2921
'` +� , � ►' `'�\ Bmded Thru Notary Pu* Ur d� w11 6ters11.1
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW