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! SUPPLEMENTAL
NSTRUCf 1ON LIEN LAW INFORMATION:
Not Applicable MORTGAGE COMPANY: � Not Applicable
1=5# NERJEN INE
Name:
d Name' i
Address:,,
_ Address:
Cdty. !4
State. City: State:
Zip. P
e - _ Zip: Phone:
FEE SIMPLE TITLE M
WER: Not Applicable
WNDING COMPANY: Not,Applicable
Name:
Name:
'-'�
Address:
Address•
City:
City: I
4 tne:
Zip: Phone:
Zip: Pf
OWNER/ CONTRACTO
t AFFIDWT.* Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or i
llation has commenced prior to the issuance of a permit.
St. Lucie County makes
lotion that Is nti a Menn+f will authorize the permit holder to build the subject structure
which conflicts ''th arty
Homeowners ssoc rules, by.aws or and covenants that may r or prohibit such
structure. Please consult
your Homeowners Association and review your deed for any restrictions wh may apply,
in consideration of the gn
r ting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance with the a
plans, the Florida Building Codes and St. Lucie County Amendments.
The following builchng pelftit
applications are exempt from wing a full concurrency review: room additions,
accessory structures, swi
ing pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNE
Your failum to a Notice of Comrr4ttcem*M may result In proft twri+re for
improvements to
r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and
steel on the jobsite before the first inspection. If you intend to obtain financing, consult
with tender or an
rite before commencing work or recordingr Notice of Commencement.
/Contractor as Agent for Owner
w
Signature of owmer/
STATE OF F
COUNTY Of____�
svAillAtor amora
then day
u bed me of Physical Presence or Online Notarization
2Og4by
of
h
IZ-a-m of person making
terrsertt.
Personally Known
OR Produced Identification
i Ty of :dentd"rcation P
uced _,.
lsienatu o otary Pu
JL- Stake 9f Florida)
♦►1r Notary Pubtic State of Fonda i
Commission
( ll �' Elizabeth Giancontieri
My Commission HH 047454
,� , 5 Expires 09128I2024
ZONING SUPERVISOR PLANS VEGETATION S SEA TURTLE MANGROVE
REVIEWS
! FRO'
COtJ
R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
i
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