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DESIGNER/ENGINEER:- Not Applicable MORTGAGE COMPANY: NotApplicabie
Name: Name:
Address: Address: _
City: State: City: State:
Zip: Phone zip: Phone -
FEE SIMPLE TITLEHOLDER., Not Applicable BONDING COMPANY: Not Applicable
Name: Marne:
Address: Address:
City: City:
Zip_ Phone: Zip: Phone-
OWIMER/ CUNiRACTOR AFFIDVIT: Applicatlon is hereby made to obtain a permit to do the work and installation as Indicated.
I certify that no wart or installation has commenced prior to the issuance of a permit:
St Lucie Counntfly maces no representation that is granting a permit will authorize the permit holder -to build the subject structure
�ctture_ Please consult with any your Home Home owners and rrelview your deed ffocovenants restrictionsWhichWhich may approhibit such
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance with the approved pians, the Florida Building Codes and SL Lucie 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 accessory uses to another non-residential use
WARNING To OWNEII;;i Your fai[ure to Record a Notice of Commencement may result in your payingtWice for
improvements to your property. A Notice of Commencement must be recorded and posted on the sobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
r-nmmencine work or recording your Notice of Commencement.
as Agent for owner
of contractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA It
COUNTY ofIf1C`�'X l� ` � COUNTY OF
The ainginstrurnentwa acknowledgeeforeme Thefo oinginstru entwasacknowledg�efareme
this day of N 0 Q. to bs lr 7.0 d by thisday of VQ rn la �201 � by
Name of person makingstatement. Name of person making statement.
Personally Known OR Produced Identification Personally Known _K OR Produced Identification
Type of Identd"icati n Type of lde^ on
Ii
l+Ay Cotnmlr;si0tt (�G 256115
Commission'E.Or.+(Seal)
REVIEWS $ FRONT 1 ZONING
I COUNTER I REVIEW
TE
Notary Public State at Ftarida
Pamela Dyer-Hape
Tiny COMMARSim GG 25677bJ
Eqi»r 0M5=22
SUPERVISOR� PLANS I VEGEr'ATION I S � TURTLE I MANGROVE
REVIEW REVIEW REVIEW