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i ionalworktozejertormed underthisp&mIt—check all apply;
Piping ■Shutters ® Windows/Doors
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Floor:T-ptal Sq,Pt of Construction: Sq.Ft.of First
Cost of Construction:$ OSewer ■
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MAR,-1-6-2016 WED 12:46 PM CENTRAL SCHEDULING FAX No. 32128$6138 P, 003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: � .�Not Applicable
Name: Name:
Address: Address: I`
City: State: City: (. State:
Zip: phone: Zip: Phone:
—7—
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: i
Address: Address: I I
City: City:
Zip: Phone: Zip: Phone: I
I
I certify that no work or installation has commenced prior to the Issuance of a permit.
St.Lucle County makes no representation that is granting a permit will authorize the ermlt holder to build the subjdct structure
which is In conflict with any applicable Home Owners Association rules,bylaws or anTeoveriants 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 pians,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 ori an attorney before
commencing worst or recording our Notice of Commencement.
5lgnatur of Ow /Agent/Lessee. Signature o ontra i r/License Holder
CTATEOFFLORfDAiCI =_ e � >STATE OF CQ NTYOFORIDA �^�yyl ( p t/�.
COUNTY OF � Z_ r ► t�•i.�/
The f r oing instru nt as acknowledged b ore me The Ding inst t CA
before me
this day of��_, 20 by this day of r , p y
l Lk, ! � �lt�
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(Name of person acknowledging) ((Jame of person acknowledging
cam&,pp�
{Signature of Notary Public state of Fi Ida). (Signature of Notary Public-state lorida)
.Personally Known le� OR Produced identification Personally Known `+,_. ORiProduced Identification
Type of ldentification Produced Type of Identification Produced /n� ��LLp »++ y
�' A", C Lheritte Rom
commission N�� x ot°alisslogo 1723 omrnission No �, � F: �C slouilFA17237�
tpfres:OCP 28,20 $ ;IEicpires:ca 29,2018
$oNDSDTM
uo�u� RrDA NOTARY,bI,C
Revised 07/15/2014 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION � SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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