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"DESIGNERNG1N1 ER. —blot Applicable MORTGAGE CC4YtliPA�114Y:; � Not Applicable
Marne: Name:
Address. Address:
City: State: City. ' State:
.Zip: Phone--- Zit.. phone:',
PEEIIIF"LF iTLE4lLOEi3- Nt7t Applicable IC3N111i Cf�fidll�A$NY; �
blot Applicable
Name: _ Damp:
Address: Address. -
City:
Zip: Phone: — Zip;_Phone:
I
i OWNER/CON S'RACF OR AFFIDVIT-Application is hereby made to obtain a permit to do th;e work and installation as indjc[Aed,
I certify that no work car Installation has commenced prion to the issuance of a permit.
St.Lucie County makes no.representation that is granting a permit will authorize the and holder to build the subject structure
which is in conflict with anyapplicable Home Owners Association rules,bylaws or ar t, covenants'that may restrict or prohibit such
structure.Please consrxit with your Home Owners Association rand 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 aft respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendmerits.
j The following building permit.applications are exempt from undergoing a full cancurren.cy review-room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms.and.accessary uses to another non••resldential use
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WARNING TO OWNER:Your failure to Record a notice of Commencement may result in your paying trice 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
cornmencin ork, recording our i atic of Commencement,
e of owner/LesseeJAgc nt at _ Contractor/License Holder
d4TE OF FLORIDA g TE OF FL0!R FD _
i• kiJ COUNTY OF c ��.� ,c , � CmtINTY OE �
The forgoing instrument was acknowledged before mc, The fear Hing instru nt was acknowledged before me
t'hi"6 '.day of.� i:� ,266'by this F day oF_ a_ tsy
a..)--P .
(Name or person acknowledging) i
g �;D {Nance at raerfiun acknowledt?in
!� ,� pmt#miitittrrli�
RIMA 1/2
{Signattdre f t� u i - t e of Flcarida � c� °,,, qo`'f�. {Signature of Notary Public-S",Late of Rod °�MSmiS
SA A0 dk� a l� ti a"t � � .t5AWiI NA,
Personally KnownOR Produced Is�tsn#°3�t f w3�°�� °� 'ersonally Known OR Produce depkitication
Type of Identification ° to n; Pe of identification OR
Produced_,.� oduced�_.._..�.
CQmrnrsslQn NQ.A � `'•3*"�}'�TIkaQU:N.�.o°°C7''�°. � !':y � r .;c/'a ('�IkPM�ep" �`h"r``
tFF-�M � ! {SQ °°* 1mlfid Q l"sfSfY1na155ltaYrP+IQ: #. a} /�S`9t °°y ° �o
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REVIEWS FRONT ZONING SUPERVISOR � PLANS ' VIEGET'ATION •�SEATURTELE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
ELATE _
RECEIVED
COMPLETED )
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