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VNEP"Applicable MORTGAGE COMPANY: _Not Applicable
Name. Name:
Address; Address:
City: State: City: State:
Zip: _ Phone__,._ Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 Coun 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 dead 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.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 accessary 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 PROIPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON TIME 108 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WffH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF MENU
Signature of Owner/ ee/Contractor as Agent for Owner Signature of Contractor an
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFaTLVCJE COUNTY OFsrLu
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�� day of_ Qac F pi t3>rn .201�+ by this tet-wday of Of-ft 9—M df-:�2 .ZO 1 gg by
JOHN PANKW JOHN PANKRAA
Name of person making statement. Name of person making statement.
Personally Known,,X OR Produced Identlfication Personally Known >6 _OR Produced.Identification
Type of identification Type of Identification
Produced •NII�NAEDEWrrr Produced
1+C-Stake of F1asi a�' vf';_., KONNI CENAE DElw �
µ NotsryPoh NotaryPubrir-State
My Comm.Ecbrnwwon
xpires Dec 10�202/ : � Cammissson#GG(Signet of Notary tsu tic='st (Signature o Notary pu ic-'4th%*bf gbamitlaa !,rmna�,ri
Commission No. 6610911_ (Seal] Commission No. G61I'f (Sea()
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SFA TURTLE MANGROVE
COUNTER REVIEW REVIEW .REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.