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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 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 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.
The following building 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 RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU NTEND TO OBTAIN FINANCING, CONSULT
WITH YOVR LENDER OR AN WORNEY BEFORE RECORDING YOU OWICE OF COMMENCEMENT."
Z'
Sig ure of Ow er/ Lessee/Contractor as Agent for Owner
Sighature of ontractor/License Holder
STATE OF FLORIDA rroP�NotaryStateofFaorida
COUNTY OF Lt ><.�. ite
•mission 367402
7oi Emy,s08/19/2023
The forgoing instrument w e o e
this i `` day of $-&,r- L , 20_�by
TATE OF FLORIDA
UNTY OF v( V ,ice " Notary Public State of Flo
r
-? MY Commission GG 3674)2
e fo,� �r o�ing instrument was ac owRd4ed &f6?kgW69/2023
is ► 5"' day of
ici
Name of person making statement.
Name of person Making statement.
Personally Known OR Produced Identification
Personally Known L' OR Produced Identification
Type of Identification
Produced r blic State of Florida
Kerri Lee Hite
-zot� a My Commission GG 367402
'k �,ff,� Expires 08/19/2023
Type of Identification
Produced y--�j�aty Public State of Florida
# Kerri Lee Hite
�+•. My Commission GG 367402
��i o�Ay� Expires 08/19/2023
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. 3U Z (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19