HomeMy WebLinkAboutPugliese Permit App AC pg 2 001SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: Not Applicable
Name:
MORTGAGE COMPANY: —Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit
no
the permit holder to build the subject structure
r and covenants that may restrict or prohibit such
.ed 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 exempt from undergoing a full concurrency review: room additions,
accessary 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
commencine work or recording= vour Notice of Commencement.
Signature of Own J Agent/ ee Signature of Contractor/License Holder
STATE OF FLSTAE OF FL
OUNTY OFORIDA 'k. W&
COUTNTY OEORIDA �1 • l t�t�iJ
The forgoing instrument was acknowledged before me The fo oing instrument was acknowledged before me
thisr��ndl,day of 20 Eby this .day of Pa(.ctu� 20 1$6y
k�1dG61c 50,14b
(Name of person acknowlecl'ng) (Name of person acknowled 'ng )/J
(Signature of Nota ublic- State of Florida) (Signature of Notary lic- State of Florida )
Personally n 1� - Person lloK wn _ OR Produced Identification
Type of Ide Stor�,Produ CONWELL Type o e Q on
Notary Public - State of Florida �m"YoIC801MIMIule'XICpae, tate of F
mmission N Q6�3YJ939CommtGG 017
My Comm. Expires Aug 21, 2020 '%'�s Aug 211
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS