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Fill in fee . • Title Holderpage(if different E-KO;
from the owner listed ..• or •
if Val je of construction is$2500 or rnore, • •
AUG-04-2017 FRI 02:27 PM CENTRAL SCHEDULING FAX No. 32126$613$ P, 003/004
DESIGNER/ENGINI;ER:
Not Applicable MORTGAGE COMPANY: �Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
zip: _Phone: Zip• Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: ' Address:
City: City:
zip: __Phone: Zip:_• Phone:
1 cerer"at no work or installation has commenced prior to the issuance of permit.
St. LuCie Counter makes no representation that is granting a permit will authorize the permit hoiderto build the subject structure
which is in conflict with any applicable Home owners Association rules,by 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 BuIld)ng 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-residentlal 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 6wner/Agent/L ee Signature of Con ctor.License Holder
STATE O' FLORIDA STATF OF FLORID
COUNTY OF — � � COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_14 this day of ,20_14 by
(Name of person acknowledging) {Name of person acknowledging)
(5jgnature of Notary Public-Sta a lorida) (Signature of Notary Public-State of ri a)
,Personally Known 4r OR Produced Identification Personally KnownOR Produced Identification
Type of identification Produced Type of Identification Produced
Commission No.�1--�
1
.. Commission NU� �� ��'f aijvethertnt��ri 11.L -12— (Seal}
� �;Cammfsslon#FF1723 2 ���",Y Catherine)(()g
Revised 07/15/2,014 At MPwRmANOTARYLLC ••t, 00 goT11
-8 t)L7` 8,'2018
�u 3STFI0IUDAHUTJgiR'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS