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COMPANY:_NotApplicable
Address- Address_
City- State: _ City: State:
Zip: Phone Tip: Phone:
Address. —
City:
Zip: Phone:
Zip:
-dot: Applicable
-,.+.+..w.c �.ce� w!lau.i seexi r siv..ac asarl a Ft1X91J uutx utw rz it your ue ror any sres ircuo s, w-rucis may apply.
In consideration of the gean5rogof flits requested permit I do hereby agree that I will, in aft respect, perform the work
in accordance with the approved FLans; 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 gaols, fences, walls, signs, screen rooms and accessory menses to another non-rgiderl use
WARNING TO OWNER: Your failure to Record a Notice of Commencement array result in Vow paying twilice for
improvements to your property_ A Notice of Commencement strut be recorded and posted on time jobsite
before the first inspection. if you intend to obtain financing, consult nth lender or an attorney before
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Signature of Owner/ Lessee)Cnntractor Agent fen ner
Signature o. ContractorlUcense Horde�r
STATE €3F FLORIDA ' . , A �
COUPOF
ATi'E OF FLORIDA
COUNWOF
The forgoing instrumentwasnowledged before me
The forgoing in was itanowtedged before me
this 3 C day of wee o r c Q/C . 2 L9 by
this, o day of 20_0by
Mid F % le,
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NamPersonally
of perso statilment
Known OR Produced Identification
Poescnatiy Knowrst R Produced deri frtation
Type of Identification
Type of Identification
Produced
Produced
(Signaha to €larida)
(SignaturneorAio#ary c--State of Florida }
�p.•�pv">'�a�� CHRISTINE J.
Comm ry.2unm{ie - State
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ate o Florida
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My COMM. Expires Aug 21, 2020
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REVIEWS
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812117