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MAR-04-2016 FRI 00: 24 AM CENTRAL SCHEDULING FAX No. 3212686138 P. 003
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DESIGNERIENGINEER: 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:
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 Horne 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 exemptfrom 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. '^y
5lgnature oflownee Agent/Lessee Slgnatu(e of Co r7actodr/�Lficeinsa Holder
STATE OF COUORI
COUNTY OI >�l�t i IUCL
COUNTY OF STATE OF ORICtA
The f oin n u nt kn I ,d a��^efore me The f oing Inst eat w s acknowledge before me
this day of Y _ , 2D Jh0>7 this day of�Q��20 y
Y-�� -yafcc -- (PoDcxA -e- -
(Name of person acknowledging) (Name of person acknowledging)
(51gnature of Notary Public-State of Florl a (Signature of Notary��Pu++blic-State of Floda
Personally Known " OR Produced identification Personally Known c..�.-OR Produced Identification
Type of identification Produced Type of identification Produced
.411rl nuCommission No -' ` .,5 ammks iur]4FF1723 „:+ thO1'b18 8W
ommission No.
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.OF
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
aOSEYH R. 3KITF, Cr-M�- OF IBE C=:T 07-M - SAIN7 LUCIE Coumm
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