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Building Permit.
Application
Planning. Development
Bulidthg and Code Regulatfon Division
I/Virginia Avenue,Fort "
Phone: 462-1553 ♦ Commercial ■ - •
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DEC-12-2017 TUE 04:08 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003/004
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DESIGNER ENGINEER: �,k
Not Applicable MORTGAGE COM ANY; _Not Applicable
Name: Name:
Address: Address: ---- 11 �-
CitY='- _ State: City: II State:
Zip: Phone Zip: Phone:
II
FEE SIMPLE TITLE HOLDER: �Not Applicable BONDING COMPANY- Not Applicable
Name: Name:
Address: Address: II
City:, City: T—
Zip: Phone; Zip: Phone-
OWNER/
one:OWNER/CONTRACTOR AFFIDVIT:Application Is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the Issuance of a permit-
St.
ermitSt.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 Home Owners Association rules,bylaws Grand 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 Building Codes and St.Lucle 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 accessary dses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencementmlay result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
1 before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement. I�
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5ignatur of wner/Lessee/Contractor as Agent for Owner SignatureC ntradtor/License Holder
STATE OF FLORIDA STAVE OF FLORIDA
COUNTYOF Jw) COUNTY OF
I LU
The#o ping ins �ehtwa aclypow[edggd before me Thef r oing Instr lent was acknowledgegd before me
this 1 day of LK zor] by this day of 20 17 by
Name of p r on making statement Name of person making statement
Personally Known, OR Produced Identification Personally Known�OR Produced Identification
I Type of identification Type of Identification
Produced produced I�
� ibiu
(Sl ure of Notary Public-S Flor' (Signature of Notary Public-Stat Florida)
Vit6rine Konger
Commission N c on#FF172372 I r Cathexitle,Konge;c
Commission No. � ''-=G ioD#FP172372
'` S':=28,2018
.r BONDED THRU �;C� �' 1Tes:OCT 28,2418
' •a` 1lirFLogIDANDTAAxLLC gj1NEONDEDTHRU
��n,n � 1ST FLORIDANof ►,j,(.'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SFA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev.8/2/17
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