HomeMy WebLinkAboutapp pg 2:=f`i±|±i,;±±+2=ds=J£;igifes;se±i=3iasii-=£2REgriRE3fikiieiseisssfi:ee
ck
DE§iGNEfi;ENayiNE`ER:~ * `' Not Applicable MORTGAGE COMPANY: Not Applicable
Name.Name.
Address.Address.
City : State :City: State :
Zip: Phone Zip: Phone:
FEE SIMPLE Tl TLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name.Name.
Address.Address.
Cit.City:
Zip: Phone:Zip: Phone,
OWNER/ CONT RACTOR 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 issiiance Of a permit.
i#cu!cj::::Ten:t!:cm::w:i:i,:aorfahpp;aJi:Fn#:t#:5haai!isgiarsgst£,!aotaf.Pan:i:a:n:tr#t;;?a!;yr%o#z!:t:f#rga#;e3s!:richtigniua#i:#ri#:pFg;ytTriubilusruech
ln consideration of the granting of this requested permit,I do hereby agree that I will, in all respects, perform the workinaccordancewiththeapprovedplans,theFloridaBuildingCodesandSt.LucieCountyAmendments.
The following bui ding 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 resuliTci:ocv:umn:'tasntdoftgts:t:enger;E#yri.eoA::ii:ig::o:irn:g:!e.in:i:r:tcfTTE:n:!E::i:b!e:kejntoi::withlent in paying twiceneddt;notBteapnuf?L]ofCommence forcrecords of St.ancing,consultment.
vl.:/-.i..,;-i!in.
stlch*u;e'otlowr#Ly&:eEICofntrysorasA8eutforowner
STATE OF FLORIDA t\A,A.ACOUNTYOF
:hYs°ffL°aryaofff'rmed|a:\iubscrlbed beforemeof L£Physlcal presenceor online Notarizat|on20Aby\
Name of person making statement.
Personally Known `/ OR produced Identification
Type of ldentificat. n Produ
~. ---f ';-,
(Sfro'tureo"j}JrypubltestaTteofflorida)
comm,ss,on NO GG9#r7C7G ts :¥H:gr£S::.-#Tifey:;:g¥J§mar"9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
ev5/ZJD|Zl