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Address:
City: State:
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DESIGNER/ENGINEER: —Not Applicable MORTG/ GE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDIN 3 COMPANY: _Not Applicable
Name: Name:
Address: ' Address:
City: City:
Zip: Phone: Zip:. I Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obta n a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of permit.
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,bylav's or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review you"r deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l 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 building permit applications are exempt from undergoing a fulll concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms anaccessory 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 miust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, co sult with lender or an attorney before
commencingwork or recordingour Not' e of Commencement
Viature of caner/Lessee/Contractor a for Owner Signatur of Co ractor/License Holder
STATE F FLORIDA q� STATE PF FLORIDA
COUNTY OF COUNTYOF
The for ng instrument was acknowledged before me The for oing instrument was acknowledged before me
this day ofC,trtQ ,20�by thisdLay of �r�t� D� .20 by
(Name of person acknowledging) (Na meLfperson acknowledging)
(Sig ture of Notary Public-State of Florida) (Sitl re of Notary Public-State of Florida)
Personally Known OR Produced identification Pers nally Known L""/' OR Produced Identification
Type of Identification Type of Identification
Produced! Producied
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLAN VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE\� REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ��a'v�". 1USTI DAVIDCONE
COMPLETED°; 44; Notary Pub c-State of Florida ` � ¢f; N tary Public-State of Flo ida
n#GG 19651
ev. ' r My Comm.Ex f res Mar 14,2022 FF My Comm.Expires Mar 14,20.
v GF F�;..••' p 111 Al�� .
Bonded through National Notary Assn. �ond�d through National Notary Assn.