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DESIGNER/E-NGINEER; Not.Applicable IyIORTGAGE CONOPAN' _'Not Applicable
.Name � Name:
Address: Address:
City: State: City: -State:
Zip: Phone, Zip: Phone:
FEESIM _Not.Applicable BONDING COMPANY: Not Applicable.
:Name: Name:
Address: Address:
City, City:
Zip`. Rhone: Zip:.. Phoney
CiWNER/CONTRACTOR:AFFTDVIT7;Application`is hereby-made to obtain a permi to do the;workand installation as indicated:
certify:that no work orinstallation.has commenced prior to the issuance of a,permit:
St. Lucie Countyy.makes no;representation that is granting;a permit will authorizeahe permit holder to build the:subject structure
whieh.is.;in conflict;with any,applicable Home-Owners.Association rules;bylaws or and covenants that may restrict or prohibitsuch
structure,:Please consult with'your Home:I wnprs,Associationan'd review.your deed„for any restrictions:which May apply.
In consideration of the�granting of this requested:permit,I-do hereby agree that.f will,in all respects,perform the work
in`a cordance vuith the approved plans,the Florid.'.Building Codes and St-..'Lutie County At6endrients:.
The following building pot nit applicationsare exempt from undergoing;.full concurrency review:room additions,
accessory,structures,swimming,pools;fences,walls,signs,.screen rooms andaccessory uses:to.another.non-residential use
WARNINGTO QWN.FR:-,Your bilure:to Record.,Notice of Corti�nencemient may result in your paying twice for
improvements to your property A.Notice-of Commencement must,be,recorded and pasted'o_n the;1obslte:
before the first inspection: If )u;intend to obtain fi:nancing,:consult:with lender or-an attorney before
commencin work or:recordin our Notice of Commencement.
ignature of owner/Less;,e, gent Signature of.Contractor/Lien Holder
STATE',OF FLORIDA STATE OF FLORIDA .
'-, t
COONTY'OF S'�- 0,1 COUNTY OF '- LIU 11:1`
The f tog instr e t was kno ledge before me The sr ging ins en was 'ck owI dged.before me
this day of - .� '261 by thi s day�:of r( i ZO by
(Name of person acknowledging) {.Name of per,son.acknowledging')
4 (A
(Signature of.Not: Pu Ifo-State o Flora a') (Signature oflNb ry Publ" State of Florida,
Perso.:nally Known Personally Known Prndu
Type of Identification1�i STACEfGARCIA Type of Identificatign r� *� STACEYGARGU►..
Produced :-: `hlY,ColV�titIS510N'eFFOD66=6 rs Produced. t hrfCCh4�d+tSSi0f�9FFOD6826
», RES:May 16,2017
U - IFI@S:May W.2017
e,P �o ryPUWicUifde�rt}te ." 800dcQFtiiuFiata�PuF� Undan ers.
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Commission No. Commission No.
r . . , . Fri .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION $EA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
tdMPLETED,
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