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Building Permit Application OCT 2 6 20%
Planning[ r Development
Building and Code Regulation DMAm St. Lucie COUnty, FL
230 Wrgibla Avenue,Fait Pierce FL 34M
Phone: . Residential
PERMIT APPUCATION
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R: Nat Applicable 7A7Z
GECOMPANY: NotApplicableName:Address:City: State• : State:
MIX, Phone.• Zip: one;
FEE SIMPLE TITLE MOLDER: _ licable BONDING COMPANY:. Not Applicable
Mame_ Name-
Address: Address•
.Z!p: Phone: X Zip: Phone:
I certify that no work or installation has commenced pd orto the issuance of a permit.
St.iude Irou ma nn rep on that is gKahting a permit will authorize the R holder to build the subject structure
which is in conflictw any appiicab 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.grarWng of this requested-perrrik I do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Budding 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,slgns,Screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Nafte of Comnwncement may MmIt in your pa"twice for
improvements to your prop".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 your Notice of Commencement-
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Signature of own fjrctor as for owner Signature of rjfice 141older
STATE OF FLORIDA STATE OF FLORIDIA
COUNW OF COUNTY OF
The forgoing instrument w0sacknimledged before me The forgoing instrument was admowiedged before me
thisday ofZQ y this day of QgQ by
{Nam of person actno Wedging)J (NameoF person ackfiGwIedgirej
t
(SidnatureofNonryPmbli tate of florida) (Sign lure of Wary Pub' teoflorida)a
Persoaslly Known Personal Known_OR Produced Iden
tificatFonORProduced identifcation
Type of lde tries ion Produced Type of Identification Produced,
Commission No. Commission No. p» e
WMICH LLE THOMAS 'J �� INICHI�L OMAS
0796 IR MY COMMISSIONOFF106796
f 20'18 !tick ., EXPIRES March 23;.2016
devised�7 EXPIFi�s March 23, ,w.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTW.F MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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INITIALS