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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
INEER: x Not Applicable
Name: s Ergnmus'Edarard Rorke
Address: 4nSeftcl
City: — — State: Ft.
Zip: 3Mr Phone
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name,
Address:
City: State:
Zip: Phone:
x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDViT: Application is hereby made to obtain a permit to do the worst and installation as indicated.
I 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 Home 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, hkh 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 full eoncurrency 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
improvements to your property, A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the Iobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
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Signature of Own r/ Les a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF m—
Sworn to for affirmed) and subscribed before me of
x Physical Prese ce ar Online Notarization
this --5- day of Nl2YlT 2024 by
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced l' A
(Si8f7atbre cf Notary Public- 901
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Commission No rr ssia2 #'1
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REVIEWS I FRONT I ZONING
COUNTER I REVIEW
DATE
COMPLETED
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Signature of Coneactor`f�icense Holder
STATE OF FLORIDA
COUNTY OF --
Sworn to (or affirmed) and subscnbed before me of
x Physical Presence or Online Notarization
this a day of N ]1�°1i1�� , 2024 by
Jonathan 9lar alt
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
F Notary 6ublic- Si/
l ^'0. rw Notary P-bl,c State of Fu
No. r GM la Staples
Mjanm,. n GG 235
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SUPERVISOR I PLANS I VEGETATION j SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW I REViEW I REVIEW