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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
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Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
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 such
prohibit
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.
��a iuuvving cuud;ng permit appiicaiiOnS are exempt from undergoing a full ccncurrenc'y review: morn 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. Ifyou intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
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STATE OF FL RI
STATE OF FL R
COUNTY OF
COUNTY OF�vCj zit
Sw rn to (or affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or _ Online Notarization
Physical Presence or Online Notarization
t is _ day of 2020 by
this day of 2020 by
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Name of perso aking statement.
Name of person making Ytatement.
Personally Known OR Produced Identification_
Personally Known OR Produced Identification/
Type of Ide 'fication ) _
Produced
Type of Ident' ation
Produced
(Signature of Notary Public-)6to F ored24u��
(Signature of Notary Public- to of Florida ]
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Commission No. Notary
Commission No. Notary Public (Seal)
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