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Signatur Owner/ Lessee/Contractor as Agent for Owner
Signa re of Contractor/License Holder
STATE OF FL RIDA
A` -'e
MORTGAGE COMPANY: _
Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
COUNTY OF
Sw,ofxlto (or affirmed) and subscribed before me of
Name:
Physical Presence or
Address:
✓ Physical Presenke or Online Notarization
this oL \ day of
Address:
this �,\ day of L 2020 by
City:
State:
ent.
Name of person maki7�®R
City:
State:
Zip:
Phone
roducedIdentification
Zip: Phone:
Type of Identification
FEE SIMPLE TITLE
HOLDER: _ Not Applicable
Produced
BONDING COMPANY: _Not
Applicable
Name:
,W% Notary Public State of Florida
Signature of Notary Public- St a riddl1ta Public State of Florid
Margaret E
Name:
•�
(� h on GG 2149
ommission No. ly lV a� t+f 1451^m/05/2 GG 214990
06/0512022
Address:
Expires
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Address:
FRONT
City:
SUPERVISOR
City:
VEGETATION
SEA TURTLE
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Rev. 5/6/20
Signatur Owner/ Lessee/Contractor as Agent for Owner
Signa re of Contractor/License Holder
STATE OF FL RIDA
STATE FLORIDA
COUNTY OF 'S4
. I`Iy, IE'.
COUNTY OF
Sw,ofxlto (or affirmed) and subscribed before me of
Sworn -to (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
✓ Physical Presenke or Online Notarization
this oL \ day of
2020 by
this �,\ day of L 2020 by
C� Yn2 .S V�GA
ent.
Name of person maki7�®R
Name of person making statement.
Personally Known
ersona ly oy
roducedIdentification
Personal! Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public-
,W% Notary Public State of Florida
Signature of Notary Public- St a riddl1ta Public State of Florid
Margaret E
ry��r,�{et E Montepare
Commission No. any �D1Pntepare
missionGG214990
01 0A 06105/2022
•fiCW
•�
(� h on GG 2149
ommission No. ly lV a� t+f 1451^m/05/2 GG 214990
06/0512022
0
Expires
%001~
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20