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DESIGNER/ENGINEER:
Name: -_ Not Applicable
Address:
City:
Zip: _ Phone State: —
FEE SIMPLE TITLE HOLDER:
Address:
City:
Zip: Phone:
)RMA 'ION
MORTGAGE COMPANY:
Name: _ Not Applicable
Address:
City. State;
Zip: --- Phone:
Not Applicable BONDING COM ANP Y
Name:
Address:
City:
Ztp: Phones
—Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation I certify that no work or installation has commenced prior to the issuance of a permit.
n as indicated.
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 m
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, may restrict or prohibit sh
in accordance with thea y
approved plans, the Florida Building Codes and St. Lucie County Amendments, erform the work
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
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF use
POST FOR THE
a SITE F YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
CON EN MAY RESULT IN YOUR PAYING
POSED R THE JOB SITE BEFORE THE FIRST INSPECTION. F YOU EIITEND TO OBTAIN FINANCING CONS
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT
s ULT
Signatu f Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF I A)
The forgoing instrument was acknowledged before me
this ayofl Piq/ L
201V by
MANY G z_
Name of person making statement.
Personally Known VstOR Produced Identification
Type of Identification
(5ignafure of t
Public Stats or FtorWa
Commission N • Jonathan G Hu ea��
�1faalon ,� X849
ar �rss 013072023
RIVI!EWSj FRONT I ZONING
COUNTER REVIEW
RECEIVED
COMPLETED
d W Ul 40ntractor/License Holder
STATE OF FLORIDA lM
COUNTY OF TIAI
The forgoing instrument was acknowledged before me
thisay of I L,
--��_ 20.&� by
y C.c>L Cf►1I
Name of person making statement.
Personally Known _4efl_�OR Produced Identification
Type of Identification
MOtdry Publ Stats Of Florida
Ca rn m i s Jonathan G Hurd
I
ExW 383849
SUPERVISOR I PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW MANGROVE
REVIEW REVIEW