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D NER/ 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:
E� Zi p : _ Phone : Zip : Phone :
Er
NER/ CONTRACTOR AFFIDVITO. Application is hereby made to obtain a permit to do the work and installation as indicated .
I ce rtify t h at nc lvro r k o r in stallation has com m e nced pri or to the issu a nce of a pe rm it .
�ASt . Lucie County makes no representation that is granting a permt will authorize the permit holder to build the subject structure
I
hic is in conflict with any applicable Home Owners Association rules, bylaws or and covenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
�`tn consideration of the granting of this requested pe rm it, I do hereby agree that I will; in in all respects, the work
' in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments .
The follovA*n g bu il d i ng perm it a p pl ication s a re e xem pt fro m u n de rgo i n g a f u l l c o n c u r re ncy review : room a d ditions,
accessory structures, swimming p ools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
ARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twke for
improvements to your property . A Notice o must be recorded in the public records of St.
Lucie County aid posted on the jobsite before the first inspection . If you intend to ob tain financing, consult
with lender or - an attorneybefore co mencin work or recordin ! our Notice of Commencement .
Signature of ne Lessee/ContraMEMO
ctor as Agent for Owner Signature of n tra ctor/License H older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF T . �L..1Cf-� COUNTY OF
Swor o ( or affirmed) and subscribed before me of Swo o ( or affirmed ) and subscribed before me of
Physical Presence or Online Notarization Ph sical Presence or Online Notarization
this �_ day of MQU . 202 by this day of M 202� by
Name of person making sta ent . Name of person making sta ement
r.
Personally Known OR Produced Identification PersonallyKnown MEOW OR Prod uced I d e ntifi cation
Type of Identification Type of Identification
Produced Produced
k6111111111111111111
ID
(SignaturU of Notary Public - S nat r of Notary Public- State of F r d
{; "W Notary Public State of Rorid ! Notary Public Stat 01 lorwa
� Commission No. 9 � ` + A � �a� aret E Montepare � 1 ` '� � Margaret E Mont re
( � t My ommissionGG21a990 Coy mission No . C< �. i � � MY ca"W"J"ion G 990
7a �� Expires 0610512022 � � � ExPres 0alOSJ202
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW R EVI EW REVIEW
` DATE RECE IVE D
DATE
CO M P LETE D
eV . to/ b/ Zo