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DESIGNER/ENGINEER: _Not Applicable. MORTGAGE COMPANY: _Not Applicable
Name:. Name:
Address: Address: .I
City: State City: Stater
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: 'Address:
City: city:
Zip: Phone: Zip: Phone: I
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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,l 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
tornmencing work.or recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this It-day of OCT- . 20 y this Z2,day of ®�- 2020 by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature ol Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR.Produced Identification
Type of Identification Produced Type of Identification Produced
Commission N&� ol% (Seal) Commission Ncl�n (Seal)
mmary ubiia sine of Florida
Ir. 1-116 Karyn G Karyn G Drawdy
Revised 07/15/2014 My c«nm� +GG 2e2585 My Commisalon'GG 282585
aw ExpiresOy11J2023 jaw Expires02/11/2023
REVIEWS FRONT- ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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