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INFO MUST BE COMPLETEDFOR APPLICATION TO BE ACCEPTED 7
te: Permit Number, I
RECEIVr-ED JUL 19 2016
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Buildhig Permit Application
Planning an Development Services
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Residential
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PERMIT
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DESIGNER/E GINEER: ____Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State,__ City: State
Zip: Phone Zip: Phone
FEE SIMPLE LP HOLDER: �Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:_ Phone:
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I certify that nQ;work or installation has commenced prior to the issuance of a permit.
St,Lucie Count ;makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is In con-Act with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas consult with your Homeowners Assoclation and review your deed for any restrictions which may apply.
In consideratior�'of the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work
in accordance wlth the approved plans,the Florida Building Codes and St.Lucie County Amendments,
The following b}jildIng permit applications are exempt from undergoing a full concurrency review;room additions,
accessorystruj�res,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
imp ovemenfs to your property.A Notice of Commencelent must be recorded and posted on the jobsite
bei a the fist inspection. If you'ntend to obtain financl ,consult wit lender or an attorney before
com encin il, . din r Notice of Cpmmenc . ant.
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5ignat a of e e Sig ure o Co tra ce se Hold
STAT I OFF f RID STA E OF GRIDA�*
COU O II'' COU OF
The for oing in 1tru en as cknOwledged before me The f r oing inst en was acknowledged before me
this day a 20 y this day of 20—LOy
lu
(Nam a so acknowle ng) (Name of pe on acknowl d ng) i
tgnature of tary Pu lic-State of Florida} nature of No ry Public-State of Florida)
Personally K Y" OR BEddKNI73112217
atia Personally Known t [cation
Type of Iden °oiul Public- orida Type of IdentificationMy Cc mai. Expir0 =r- `�•_ NNE RUSSEL„ ryP tare et Kforida
Commission ommission92 Commission No. � 1�
My'Con:m.Expires Jul 22,'2017
COr7r
mission#FF 0383
Revised 07/ 5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
COMPLETE
INITIALS
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