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..11 1:1-31POUNMEMEll MT21 �
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DESIGNER ENGINEER: ,X Not Applicable MORTGAGE COMPANY-, )0 Not Applicable
a e�
Name: N a MORTGAGE
Address- Address:
city: Stater City: State:
Zip: Phone Zip:_Phone:
FEE SIMPLE TITLE HOLD X
ER: Not Applicable BONDING COMPANY; Not Applicable
Name: Name:
Address: Address'.
City: City:
Zip: Phone: Zip; Phone:
OWNER/CONTRACTOR AFFIDVIT.Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a 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 Assoclation rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners As5ociation and review your deed for any restrictions which may apply.
In ronsideration 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.
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 OWNEW. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IM pROVEMENTS Tip YOUR PROPFATY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMERCEMIENT.-
Signature of Clwner/ Xee/C�ontracto�rasAge�ntfar owner Signature of ConIfVE n se Holder
,gr
STATE OF FLORIDA STATE Of FLORIDA
COUNTY OF sr, (,I)C 165 COUNTY OF — sr- W C g IiS
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_D_day of Vakt, 2a_11 by this 11 day of V�41L- — ,20 L"i by
'5410 epwKitprL_ 16*0 e PoI L_
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced REWIT] Produced
t 0* I(ONNI LENAE DEWtTT
Nam Pu o15 Notary ptibk-State at Florida
Cam Q0111 5iCA#GQ166915
My Cornm EKplres Dec
Wffia*,wdtm*Naftt*1 N&IFYAW
c 1q 202
{Signature—oTNotary 1.11 (Signature of Notary Public-StJe'gT,'
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
PATE
RECEIVED
DATE
COMPLETED
kev.2/7/19