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PERMIT
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Project'Site Plan Name:
Block No.
Setbacks Front Back: RiFtht Side: Left Side-'I
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Electric Plumbing Sprinklers F-1 Generator I Ro0i f
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ost of . . aUtilities: Sewer Septic :, ,Building Height:'
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Fill in fee simple Title Holder on next page
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:' Not Applicable
Name: Name: I
Address: Address: ;I
City State: City: II I State:
Zip: Phone: Zip: lhone: I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ! ; '`Not Applicable
Name: Name:
Address: Address: II
City: City: !I
jZip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
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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 Home Owners Association rules;bylaws 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 appy:.
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. $
IThe 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 inyour paying twice for
improvements to your property.A Notice of Commencement must be recorded a'rid pasted on the jobsite
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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Signature of Owner/Lessee/Agent Signa-ure o rac o'r%License Holder
'STATE OF FLORIDA STATE OF FLOR
COUNTY OF [2 &e.t 06ele COUNTY OF 8eac }
The forgoing instrumelnt was acknowled ed before rrie
The forgoing instrument was acknowledged before me g g g I
this ""7 day of �vA_66 j ^ . 20 .'Lby this day of 'C - 20 Q by
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(�1�►-�ej 0,IIS S l
(Name of person acknowledging) (Name of person acknowledging)
I (Signature of Notary.Public-State of Florida) (Signatof tart'P; li O -State of Florida) }
i Personally Known OR Produced Identification Personally Known ) OR;Produced identification
Type of Identification Produced Type of Identification 0,roduced: I
II sf Fu8 1 ANGELA UN
Commission No. Commission No. o�P.•• ��
rr � -"�—"3 Nil WNM'$SS � 51069;
F * .'. * pol12.2020
- W�yyppC��QM��I�t$�i M 14607 u 'AZ EXPIP.ES:A
? W.rII�G4:September22,2019
Revised 07/15/20 1 Q`t°P� 8ondod nwttabryt�u kur
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ! SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW
IDATE I
j COMPLETE
LINI�ALS
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