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State: A-l
City: State:
FEE SIMPLE TITLE • 1EK:
Name:
—NotApplicable
BONDING•MPANY: —Not Applicable
Name:
Ad
Address:
Cit
City:
•
•
F
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 jobsite
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.
A
Signature of Owner/ Agent/ Lessee/Contractor
Signature of Contractor/License Holder
STATE OF FLORI¢� /�ZZ
STATE OF ORcDgC� / • •�
COUNTY OF c, T" f 1 J
COUNTY OF y �/� '
The for oing instrum nt was acknowledged before me
�
The fo oing instrunlent was acknowledged before me
this day of J 20,aby
this day of 1✓G�/! 20f a by
�2 c c�rT
/
l> A 7ci2T �� �j Je u 7 A✓
(Name of person acknowledging)
(Namelcif1person ack a (edging )
ture of Nota c- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification T
Personally Known lr�j OR Produced Identification
Type of Identification�'sn
Type of Identification
Produced X/�'
Produced 9901"SHERRI FEHLMM
=P.°BG� SHERRiFEHLMAN.
`'� fa Ission#GG187160
Commission.No. lSee&mission#GG187160
Commission No. `,a� ( Mardt14,2022
EzPiresMarrh14,2022
'ni'OFF �oo- ewedTA194 11ftys
iE p op
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 772014