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AUG-30-2017 WED 07.T63 AM CENTRAL SCHEDULING FAX No, 3212686138 P. 003/004
NO
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Y
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip:_ Phone:
FEE SIMPLE TITLE HOLDER: T 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 priorto the issuance of a permit.
St.Lucie Caun��yy makes no representation that is granting a permit will authorize the perrnit holder to build the subject structure
which is in cony
with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne Owners Assmiatlon 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 bullding permit applications are•examptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 recordin&your Notice of Commencement.
Signature ort/w, er/Agent/Lessee SIgnatur of ❑ntractor(L
icense Holder
COATI"O1RID� �.� STATE OF FLORIDA . Wrj
COUNTY UF• COUNTY OF
The !rig Inst ment was acknowledge before me The f r oing instru ent was acknowledged before me
this day of \k. k' 2Q, this day of k _,,z0, by
morc We-
Rotaf
(Name of person acknowledging) (Name of person acknowledging)
a r
{Signature of Notary Puts State of Florida) {Signature of Notary Public-5t2Florida j
Personally Known OR Produced Identification _ Personally Known OR Produced Identification_
Type of identification Produced Type of identification Produced
wit3e K sager
Commission.No_ 1'1' �} 3' _gommon#PF172372 Commission N �sWerine Ktongeir
�� ices t}t`t'2B,2fli8 ! :Comt4W0n#FF172372
'.• ,t, aoxunATHRU Ila ;=fixpires:ocr28 2418
JIM
OUNUED
��,nn:�•f� 15TBL❑Rlp�[ll
Revised 07/15/2014 TARx,IC"G
REVIEWS FRONT ZONING 5UPERV150R PIANS VEGETATION SEA TURTLE MANGROVE '
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVII=W
DATE
COMPLETE
INITIALS