HomeMy WebLinkAboutconnelly permit page 2DESIGNER/ENGINEER:Not
_ Applicable
MORTGAGE COMPANY: Not Applicable
Name: rVL-
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City: 'T-'iKZa q
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FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Personally Known OR Produced Identification `'
Name:
Address:
Address:
City:
Produced iLj L Notarization
signature only,
City:
Zip: Phone:
(Signature of NotPublic- St HASSNA 5A4A3RIA
=�4 �'pui. Notary Public State of iori0
Zg� = GG 340327
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 holdento 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 her2by.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-te 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 BEFORE RECORDING YOU"OT)CE OF COMMENCEMFO."
Rev. 2/7/19
Signature of Owner/ Lessee/Contractor as'Agent for Owner
Signature of Contractor/License Holder
STATE OF ORIDA�j �
COUNTY OFSTATE OF ORIDA S* L -I -I a e-
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2`7 day of /L/C. 2021) by
this day of 20 2C) by
pa441-1 Cj ai Wfla
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Name of person making statement.
Name of person making staterkent.
Personally Known OR Produced Identification `'
Personally Known OR Produced Identification
Type of Identification Notarization validates
Type of Identi icatiop,
validates'
Produced '01aL %'L signature only,
not document content
Produced iLj L Notarization
signature only,
� IaU
s 210 not document content
(Signature of NotPublic- St HASSNA 5A4A3RIA
=�4 �'pui. Notary Public State of iori0
Zg� = GG 340327
Signature of Notary P lic-
;a• a a.. HASSNASAhA9RIA
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-112.,j/2� z �`. N lic State of Florida
Commission No. �, Sea mission
Fxwires Sul28. 202
ommission No. -�*: ;;�: i'.
omm soon G6 340327
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Bonded through National notary Ass
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REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19