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Feb 22 21 04:47p p 2
DESIGN ERf ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
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:Applicadon'is hereby made to obtain a permit to do the work and installation as indicated.
l 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 Horne 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 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:roam 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENM OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature Owner/Les a/Contractor is Agent for Owner Signature of Contractor/License Hgffder
STATE OF COUNTYOFORIDA�'' � � COUNTYOFSTATE OF Oi21 :
The for Ding instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ZFday of ,! 2D 2A by this May of 20a by
Name of person making statement. Name of person making statement.
Personally Known 2<—,—OR Produced Identification Personally Known OR Produced Identification
Type of Identificatior. Type of Ide d5cation {{
Produced Produ ed ��(i�1(� [1\ I� (iCQYI
4ignatureLof Notary P blic-State of Florida) {Signature of Notary P blic-State of i
Commission No. Q �� Ct Z�� "'�+ SHIRLEYA SAU IER
•.a!:�?, ,; SHIRLEYA.SAUNIPREVIEW
ission No. :?1..•.,gt
ram, W COM NSWON 1"929
•; .•_ MY COMMISSION#HH "'s; o�i?`,•'' EXPIRES: ,2025
_ ,�•..
•Q:
REVIEWS FRONT oprRE S VEGETATION SEA TURTLE MANGROVE
COUNTER IEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
re—v.