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DESIGNER/ENGINEER: _Not 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 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,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed 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 accessory 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 must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signatur of Owner/Lessee/Contractor a g nt for Owner Signature of Co actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ /44/1�47t COUNTY OF
The forgoing instrument was acknowledged before me The forgoing inst ument was acknowledged before me
thisZday of 20 by this day of 2020by
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(Name of person acknowledging) f (Name,of person acknowled7' )
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(Si ature of Notary ublic-State of Florida) (Si ture of Notary Pubilc-State of Florida}
Pe ovally Known I/ OR Produced Identification Pe Wally Known L-""' OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. 1 (Seal) Commission No. (Seal)
t'�y, ;' E
°r°• N ar �4p� ate f I r' OVE
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGl + a S , , ;�t~ GCi 11
COUNTER REVIEW REVIEW REVIEW REVI V��?:�Fc°�` M�VWEftiAe 14,x!/
DATE
RECEIVED ,dRY�iie,. JUSTIN DAVIDC NE
DATE '_:�, coir.- aeo on a
a• ffi•o`= Commission#GG1 6519
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COMPLETED -'.,� o?' M Comm.Ex Aires Mar 14 2022 :.ppi'iy!:. tJti I.1;)P')II (()NE
ev. BondedlhrouyhNalionalNotaryAssn. ;� ?;, (.' „ ;. t1(,'r;h'>'9
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1'1.1:' .td'1 Assn.