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DESIGNER%ENGiNEER. Not Applicable 3 MORTGAGE CACi PANY: Not Appikable
Name_ ' Name,
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Address. Address:
City. State. citr State_
Zip. Phone zip,
FEE SIMPLE WLE HOLDER Not Appikable BONDING COMP Not Applicable �
Name: Name:
Address: Address:
City:
Zip. Phone.. Zip
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O1Ji!'NERj C ONTIRACTOR AFFIDVIT. AWkaUon is her� made to obtain a wnnit to duo dw wo& and knuWatbn as tt _
i certify that no work or instaflation has ctwnmenced prior to the issuance a permkt
5t. Lucie �ou makesno rep � is grartttt a att will athe to its sl wxe
which to t�t►rft ic:t vAth may+ � Home ruts a that €tom o
structure. Please consult vAth your Yaws Ownersand review' deed Rw any rrestrictions_ � awy
In consideration of the grardiM of thFs requested wit_. t do hereW agme Owt P vwk in the
in accordance wish the approved plarts, the Florida Building Codes and St_ Lude County Auwndfnents.
The fol awing building pernift ai icatit s are exempt from and erguing a full a we teok-w. rown ad
accessory structures, swimming pWs. fences, walK sue, screen towns and " uses to awMwr nonivskkutial use
i AArMW To 01t: T4XW IEAMLiRIE TO RECO1910 A NOIRE OF MAY UESMT W YOUR t PAY=
7WKIE ,Fog UWNWyENjXTS TO VOW PROPMT. A NUUM OIF NEW MUST BE 111113COUND AND
PciSTIED ON T#K JOB SFW BEFOW THE FINST 99SPECiWK111= YOU 1101111141111110 MUM FVU101111INAG, CONSI[ T
'1y'FM YOM LIM" OR AN ATT01"WY BEFOW 21=01101M YOUR MOM 0F�C0 I�1 Iu MCE14MT.!'
Si forOwner
STATE OF FLOI A STATE OF FL,
COUNTY OF COUNTY COF
The forgoing lrtstwr ent was admoMecked t fc roe '"M fa was adaxrwleited before try
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Name of person inakin Name
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Personally Known ._ _ OR Prodtxed tde`' .j..../ __ Pasona4Known- OR Produced kienffkafion _ --
Type of !emetic 4an; Tye A
Produced Prod t�c
KATHRYN D'AM T Yp , KAiHRYN D' A M AT
'f Notary Public -State of. r [t• ,.ot�` �a��
f) •= Commisso 5 x: �cNotary Public -State of Efo d
tureofN Pctialic-5 Y ornmission Ex 'ire 9
! Y , September 14, 20 3 '�°il«+�
114,
September 2fl23e
Commission tea. -- - � (Seal) comNo-
REVIEWS FRONT ZONING SUPERVISOR MANS VEGf_-UATM SEATURIU
CC?UN'TER REVIEW REVIEW REVIEW RMEW RMEW REVIEW �
DATE
ECEIVED
LDATEED
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