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qSTRUCTIOUttER-WA
Not Applicable
Name:.
..Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Appi ic.a bi e
Name:
Address:
City:
Zip,: Phone:
'MATI0 N'
MORTGAGE COMPANY:. Not Applicable;
Name:
Address:;
City: State:
Zip:. Phone:
Name:—
Address-
City -
Zip: Phone.
OWNER/ CONTRACTOR AFFIDVIT4 Applicaticin is hereby made to obtain a permit to do the w6rk,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 a It respects, perform the Miork
in accordance with. the approved plans, the Florida Building,Codes and 5t. 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;bn the jobsite before the first inspection. If you: intend to obtain financing, consult
withJender or an atjory. before commencing work or recording your 14otyce Of Commencement.
Sign4fu're of Owner/ k�4see/Contractor as Agent for owner
Sign of Contrt Yor/License Holder
STATE OF FLORIDA
STATE OF'FLORIIDA
Y'
COUNTY OF
'COUNTY OF Wi
1w to (or,affirmed) and subscribed before me of
online
Swcirm to (or,bffirmed) and subscribed'before me of
�Online
v7physical Presence or Notarization
Physical Presence or
Notarizatione,
'day
this day of N)CY,4,elll 2020 by
this -!A—' of av-6 262c) by
LOA Vran-A
I b,�A *� V uyn- UX,
Name of person making statemLant.'
Name of person making statement.
Personally. Known OR Produced Identification. Y
Personally Known OR Produced. Identification
Type of I Idea ification
P -IL40
roduce
I Type of Identifi ''tion
Produced L 3�6 3b 14c)
-ta- Z
(Signature of Notary Public- State /if Florida
(Signature. of'Notary Public- S a" F b a-)
Commission No.. C VO;-AGE
9 of Florida
LCASSANDRA A V01 AGE
Commission No. < (S *iic ofFlonda
e, state
11023
6.
Commasslon P GG 923210
Mr gym. E xplr_% Cc, 16, 2023
onaT iotart
REVIEWS
R i
PLANS
VEGETATION
S A WHILE
10 A-P M Ao-� 'E
COUNTER,
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW;
REVIEW
1 DATE,
RECEIVED
DATE.
1,1_.COIVIPLETE.D
. . . . ..
.......... ...............
Rev. 576T20