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City:
Zip: Phone_
FEE SIMPLE TITLE HOLDER:
MORTGAGE COMPANY: Not
Address:
State: _ City: state:
Zip; Phone:
Not Applicable I BONDING
Not
I Address: I Address: I
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORF RFCORDIN6 YOUR NOTICE OF COMMFIuf FrFmT ,,
Signature
STATE OF FLOMDA
COUNTYOF.� • o
as Agent for Owner
The forgoing instrument was acknowledged before me
this�`e-day ofGjl.t`�20;ZOby
x QQQ11 &J'A A,
Name of person making seeldrient.
Personally Known OR Pr uced Identification
Type of Identificati n
Produced `�(pf2 -t i in (og a2Qa 0
(Signature
Commission No.
REVIEWS
'OMPLETED
CHERYLA HOW,
moi' Publicic-5�� Florida
Commission k GG 260038
COUNTER REVIEW REVIEW
of Cc
STATE OF FLORIDA
COUNTY OF - oi� s
The for oing instrument was acknowledged before me I
this `i.�j,c ay of ; O 2p�by
Name of person making statAmlent.
Personally Known OR uced Identification
Type of Identification
Produced Fe. so L, Q -( '�D
CGAS o � �� L ,__g
(Signature of Notary lic- State of Florida
Commission No.
PLANS VEGETATI
REVIEW REVIEW
«RML A HOWE
Notary Public - State of Florida
MY Comm. Ex ires Nnv to in„
REVIEW