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iple Title Holder or
nar listed aboVel
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cm is 2500 or more, a RECORDED Notice Of LommencemenL vs requireo
► So0 er more. a RECORDED Notice of Commencement is required.
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State'
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DESIGNER/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: Application is hereby made to obtain a permit to do the work and installation as i
I certify that no work or installation has commenced prior to the issuance of a permit.
nditated.
Si. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conffict 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 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.
d.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming peals, fences, walks, 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 jobsite before the firstinspection. If you intend to obtain financing, consult
withaender or an attorney before commencing work or recording your Notice of Commencement.
0:N:7t--'-VV %
gnature of Owner/ Lessee/Contractor'As Agent for Owner
STATE OF FLORIDA
COUNTY OF2 -tw
q
Sworn to (or affirmed) and subscribed before me of
this day of J)) rV • -. 20-:� 11 by
Name of person making statement.
Personally Known � 0
Type of Identification Produc
M&
6
`f Physical Presence or � online Notarization
40MENNEEMP-00
dined 14entificitiqn L000000or
0 1)
Signature of Notar�ubl�c State of F�rida j
Commission No. (Seal)
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
e
FRONT
COUNTER
AUDREY t3. jiUMPHREY
•�' -* �a MY
comb
ISSION It GG 3
6,2023
C+ +■ �y 'f )(PIKES
i NotaryUnderwftrs
ZONNGREVIII
S
PLANS
I I
VEGETATION
EW
REVIEW
REVIEW
REWI5
REVIEWLE
MANGROVE
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