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DESIGNER/ENGINEER: _Not
Applicable
MORTGAGfiCOMPANY.
_NotAppkable
Dame:
Name:
Address:
Address:
My:
State:
city;
-
Zip: Phone
Zip: Phone;
FEE SIMPLE TITLE HOLISMI: ,,,,,_,
Not Applicable
BONDING COMPANY:
_Not Applicable
Marne:
Names
Address!
Address. _
_ --
GW
-aty:
Zip: „__.. P +one:
ZIP:, Phone -
OWNER/ CONi'R=0 RAFFIOW. Application is hereby made to obtain a permit to do the work and installation as indicated.
I canI I than no work or lnsURatlan has commenrad prior to the ]nuance cf a permit.
1 Co#�uCCant ► mak� no re anhta�ti:ata tha ng a mlt III antporiie the ermit holder to wild tthhesub�act structure
SintstVA19�reinP[�se ranisttitaw� uir �Iwne wears saocintton and to ew yob ur didn y i�stN�an�yhtsh may aA*..111t SI i1
In conaidemtlon of the granting of the requested permit, I do hereby agree that I will, In all mpsctk perform the work
In =ordanrew th the appraved play% the Florida Building Codes and St. Lucie County AnwdmantL
The followins bundles Permitappilca#3ons are exempt from undergoing a full concurrency review: room tdditkn3,
accessory structures, swimming pools, fences, walls, Signs, screen rooms and accessory uses to another non-residential t198
WARNING TO.OWNEit: Yqui failure to Record a Notice of Commsnceme result in your p�B twice for
imppray nts�tRroparty. A Notice of Camrnence t m e recor and posted an the jobsits
befo the ape�l� If you Intend to obtain iinanci le l gi1k th lender r an attomay bef ve
sgeelCantract4rasfigent €or Owaler
STiTE o tf IDA
COUNT f OF
this Ing �yinAsfacno,rviedg esf qefflre me
LA
NamOf pelsosanaking statament
Personally Known: _OR Produced identification
Type of bAnt]Acation
(sign atuWofNotary FuirtirStat"fFloridaLin
-
cgmrntseion No, " ",, K �l E KI
dotary ublic Brat f
*- CommissioiI # G
m, comirlission
23, 2
REVIEWS
COUNTER I RNEW REVIEW
Rev.
tore of Cobtractor{license
COUNTY
The r�alas Imitrgmffltwas acknowled bafore me
this +day of • �y
Namd of pwmja�king statant;nt
Personally Known OR Produced Iclentifioatton
Type of Ideatification
Produced
' NEEDS 7U ]lc- '*f Florida)
�-KR1Sr RSY
Notary Public -state of Florid
20.
ssian # GG 925370
Comm._s t 12i
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