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City; State;
• -
milli
Zip Code: .�
Phone No -
10/09/2038 03:37 :1518 P. 002/002
Noffillm
DESIGNER/ENGINEER: `Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: city_ State:
Zip: Phone-- Zip: Phone;
FEE SIMPLE TITLEHOLDER. _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 RECOM A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYINENTS TO YOUR PROPERTY. A NOTICE OF'COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE WORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WWWTMR LENDER R AWASTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENC "
T 4
Signature of 0vhner7ressee/_Contract0 as Agent for Owner Signature of Contractor/License Holder
STATE OF FLQRIDA STATE OF FLORI A
COUNTY OF COUNTY OF
The f oi�ng in Tent was acknowledged before me The forgoing instrurnent was acknowledged before me
this �Tt ay of 20Dby this—1 day of 20
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 ced
1
r
(Signature of Notary Public--State o -• Signature of Notary Public-State of
NOTARY Pt>MI C NOTARY Pl EUC
Commission No. r ATE OF Fly Commission No. �OF FLORKA
Coimnit GG285C'A C,
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.