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HomeMy WebLinkAboutmissing signature/ permit signature pageI -- w - - - -- , .` , in ,` ae ,rs.?a-..,¥d i q .ARE ©1i!.EN RE{`as¥i;g{:§!ae!i ,'-i.i..ay``RE``ae` RES .iimgrA , v i `se# €v A - R::::Nffi6ErN&'%EE&aM£Tz###Cable wioRTGAGE COMPANY: t* Not Applicable Name: Aiddress.. LJ I lfi I .Tci_InrY I ci A i Tn:aJZL) ftl a I Address: cjfty.. . sitate.. I i City: State: T+i.. fffi3fI:jFrfrijrre -L. _ ,Zip: Phone:`-_ '\,+,- ` , ' -, I \, , \\+, EEaEms%|E/T`EiE#°#47oNzf°iA;Pg'jcab'e BONDING COMPANY:` LiNot Applicable Name: Aiddres,s.. I FTxs-< i3f9 i i -lA,yL4_izzal Address: Cjrty.. 'C, I City: Elp.. 7 PHone..,Zip: Phone: OWNER/ CONTRACTOR AFF lDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. certify that no work or installation has commenced prior to the issuance of a permit. !tfuLccu[cj::#gn:t!:!:w#,:a?wi:ahpp;a!iu:ran#:tLfi55haai|isgiars:t;:,!ao,af.Pan:i:o:n:tr,u!:!a#o#sz3gte!d#a#n:;n;e3s[,g,icrht;8nSua#!#£c:t;#:r,3yttriubi{usruech n consideration.of the granting of this requested permit,I do hereby agree that I will, in all respects, perform the work n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit app ications 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 iTcP:o::umn:'tasntdoJ:sutreEr:np#eyjoAbFi otice of Commencement must be recorded in the publitebeforethefirstinspection.Ifyouintendtoobtainfin c records of St.ancing,consult with lender or an attorney before commencing work or record ing your Notice offammencement.•-ZT?{!,::-i z -2 P-£-fc. Signature Of Owget7TLesse6/Contractor as Agent for Owner Signature of Contractor/Licensa Holder STATE OF FLOCOUNTYOF RIDA :tAUTE£FOFFLORiDAcs+`LL"p49T#Arfuor1 |r I 4) ( !BL^J^ Swo to(oraffirmed)and-su-bscr;bed beforemeof J ffis::aray,aogf::#;c]e;:±subscr:bne[:n::£2:rt:br:Z:t::nthj Physi:ay':fresifl#:*? Onlin:oN2%tabr;Zation rbey+ `f3i ^dfy5 &Ohat alets ::r:oe:Oat,:eKr::::ak#pernotduced|dentif|catlon Name of person making statement. PersonallyKnownLZoRproducedldentification TPYrpoeal°Nrflthrfiatron Type of Identification Pro ced .I,I (Sig'natd e of otarypublfe-State of Florida )_I,-.--I-----I,*-i (. tuTe-o-fwotary public-State ofFlorida ) mmission No.66 |foawfL----.- ,` _ _ _ . .:..:}RE#ng.:,::-;c%RM#3§,LonT¥¥1 - --|,,T.t, -I I ;:`:^f.IRE:::a::; wF:3!!i¥ff%g-,26o2ee"N16 REVIEWS FRONT ff.8¥itf``` Bonded Notay pLAlie ii LANS VEGETATION EXPIRES:January25mGcotyEicu _£u I V I I V u _. -' ,- COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW--tvIEW DATERECEIVED DATECOMPLETED crN.5|6|2:a