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Nam Name.
Address: caomparly
III L"WIPM 16. 2b
City: S t a T,e Addpkss: io"'re L
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Fill in fee simple Title Holder on next Page(if different
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if value of 00 or more,a RECORDED Notice of Commencement is required.
JUL-06-2015 MON 12:07 PM CENTRAL SCHEDULING FAX No. 3212686138 P. 003
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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 TITLEHOLDER: Not Applicable BONDING COMPANY: _ Not Applicable
Name.• Name:
Address: _ Address:
City: _ _ City:
zip: Phone' Zip: _Phone:
I certify that no work or installation has commenced prior to the Issuance of a permit.
St.Lucie County make 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 1 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 our Notice of Commencement.
Slgnatu a of 0 ner/Agent/Lessee Signatu of Contractor/Lts .
older
STATECOUNTY
OF FLORIDA 1 /�; STATE Y FLORID T
COUNTY OF _�, � L.4 COUNTY OF
Theo oing In e t vl as acknowledged b fore me The o going instrument was acknowledged before me
this day of 20, y tT
this , day of ZVI 20by
La-�C' L�auk I-. —
(Name of person acknowledging) (Name of person acknowledging)
V-A
(Signature of Notary Public-State of Flor (Signature of Nota Pube of F a)
Personally Known OR Produced Identification Personally Knownllc-StatOR Produced Identification
.Type of Identification Produced Type of identification produced
�� g commission No. ������ eftherine Kori ca!
V, therlae Kon e>r r 5
Commission No. , ''i,s.�on#FP1y2872
E41res:OCT 28,Z01ti< coCotamisstan#FF27287Z
W.,a,�••`'� ISTFLOPIDANOTARY,LLC •,°�` ,,,•�'1sTFLOVIUAHOTRARYMr,
Revised 07!15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS