HomeMy WebLinkAboutBuilding Permit Signature Page[NEER:
Name:
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FEE SIMPLE TITLE HOLDER:
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Name:
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OWNER/ CONTRACTOR AFFIDVIT. Application is hereb ade obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior the issuance a permit,
St_J_ucie County -makes .no.r4Drjesentation that isRr irk apermit willaLdhior, parmit.holder to -build the subierA-struaurp-
In consideration of the granting c(r this uested permit, I do hereby agree that I Will, in al spects, pericrrm the vqwk
in accordance with ap
proved pproved s, the Florida Building Codes and St. Lucie County Amen nts.
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The following building perm' pp !cations are exempt from undergoing a full concurrency review: ro additions,
accessory structures, sw ming pools, fences, walls, signs, screen rooms and accessory uses to another n -residential use ic �(
Your failure to Record a Notice of Commertco-ment zr,,,V resiAt ill paying ce tor
Ong -
f-ded in, tile pu rer-ni.-&
L ty and posW the jobsite before the fist inspection. ff you intend to obtain
11 - ft� a
obtain na, constuft
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lender or an attorne before commencin work or rarrwrliney Commencemen
azAgis tOwner �M;Awe,,1'4 CnzyAiat tci A-ke i�_ wt-y
STATE Of nC"MA STATE Of T-110RIA
COUNTY OF COUNTY Of K 4 J C
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
7 Physical Presence or Online Notarization Physical Presence or Online Notarization
Name of person making statement,
Personally Known L_� OR Produced Identification
Type of Identification
Name of person making statement.
Personally Known
OR Produced Identification
Tvpe of Identification
(Signature of Notary Public- Staff of Fil * a ' 4T " -
S155 e o ota'r, M 'r- StatFlo u _'
Notary Public toa
Commission No. Francine Ra
My COMMISSIO won401MY Public ,;;*.a Of Florida
`-- Of rti Expires 12/171 020 Francine RafF,
My COMMISS104 C
7 �,4 034947
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROX
— --- COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
5 51111 _,rF