HomeMy WebLinkAboutMattson permit application_2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER 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
phone: Phone
Name id_
City
Zip
Name _
Addrc,s· _
City.
Zip
OWNER/ CONTRACTOR AFFIDVIT; Application is hereby made to obtain a permit to do the work and installation as indicated
l certify that no work or installation has cormnened prior to the issuance of a permit
St. Lucie County makes no rcprosonmlon thatis granting a permit w,11 outho,l,e the/Jrmot h�de, 10 build !he subic<! ,trU(IU,O which is in conflict with any applicable Home Owers Association rules, bylaws or are covenants that may restrict or prohibit such structure. Please consult wthi our Home Owners Association ad review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that l will, in all respects, perform the work in accordance with the approved pans, the Florida Building Codes and St. Lucie County Amendments
he following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures, swiring pools, fences, walls, signs, screen rooms and accessory uses to another nonresidential 0g
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St
Lucie County 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. ..
s1,na1ure ol�se!f:!:::. �cnt for Owner
:,,.�.{!i!..f<.ense
Holcler
Ago:ton_ couNrY or AC1C
Sworn to (or affirmed) and subscribed before me of
/Physical Presence or _Online Notarization
this _day of ,2020b
Todd M Paroline
Name of person making sttgrent
Personally Known oR Produced identification
Type of identification
eied
Cui1.,I
(Sign.a ti, oeee.re l/corr4sy coussowoo#ew s,es exes.res»on t.ass Booe hey Pu.le
PLANS
RE VIEW
Cle (Signature of N
Po,,onally Known .....L___ OR Produced 1denlofo<o1lon _
Type of identification
tftee
like
e Ldl
Comm,.slon No {i"\..-�2' [r,if:zit
VEGETATION SEA TURTLE MANGIONE
REVIEW REVIEW REVIEW
Nae of person making statement
Todd M Paroline
STAIE OF FLORIDA ,: couNTY or 4 4LC
Swogn to tor affirmed) and subscribed before me of
\Physical Presence or Online Notarization
this day of 2020by
SUPERVISOR
RE VIEW
20NING
RE VIEW
FRONT
COUNTER
REVIEWS
DATE
RECEIVED
DATE
�PLETE00�------------�--�----�----�----
ev. 5/6/20