HomeMy WebLinkAboutVegetationRemovalPermit SignaturesPLEASE HAVE THE FOLLOWING ACKNOWLEDGEMENTS NOTARIZED:
I CERTIFY THAT: (CHECK ONE)
A. ( ) 1 AM THE OWNER OF RECORD OF Tl{E ABOVE DESCRIBED
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNERBUILDER.
DisUosure Statement State law requires consbnebbn to be dare by licensed contractors You have applied fora permit under an exemption to that law
the exemption allows you, as the owner of your property, to alias your own contractor with certain rmtnTOons even though you do not have a license.
You most provide direct onsite aiveoeiao, of the consbucbon yourself. You may build or improve a one -family or two-family residence or a farm
outbuilding. Youmaya/mbui/dmimPmwacomme ia/building,pmwdedWurcn54domtexceed$75,00O fiebui/dingaresidencemustbeforyour
own use or oaupancy. It ma y ret be built m substantially impro ved for sale a lease. If you seg or lease a bulld/ng you ha m built or s ubstantially impro eed
yourself widen I year ager the mnsM2Yion is complete, the law will presume that you built or substantially improved it for sale or lease, which it a
violation of Mis exemption. You mayret hire an unlicensed person to acr as your contractor or to supervke people worling on your building. Itis your
responsibility to make sure that people employed by you have licenser required bystate law and by county ormuniclpal licensing ordinances You may
net delegate the rerponsrbility for supervising work to a licensed contractor who is not licenced to perform the work being dance. Any person workng on
M, building who is not lireared must wed, under your directsupervisian and most be empluyedbyyou, which means that you most deduct F.L CA. and
withholding tax and provide workerscanpensaten for that employee, all as prescribed by law. Your ennsNrcho, must comply with all applicable laws,
ordinances butlding codes and zoning regulations.
B. (X) I AM NOT TH E O WN ER OF RECORD OF THE ABOVED
DESCRIBED PROPERTY; HOWEVER, I HAVE AUTHORITY TO ACT AS AGENT FOR THE OWNER OF
RECORD. (St, Lucie County Code and Compiled Laws requires that this type ofwork be done by a licensed
contractor. PLEASE PROVIDE DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH THIS APPLICATION IS TRUE AND COMPLETE TO
THE BEST OF MY KNOWLEDGE.
AGENT SIGNATURE CTOR SIGNATURE
STATE OF FbaktBA,UIr4I M
COUNTY OF ST. LUCIE CCAS
Theferegoingins mentwaspicknowledged
before me this . Tday of Nd ✓, 20.20
who is
menially know to in or has produced
identification.
posture of Notary //
k-51le '4
Type or Print Name of Notal
Notary Public WV Title
Commission Number
STATE OF FF,9IFH)A, s LxCOUNTY OF OF ST. LUCIE DL -,:—
The foregoing instrument was{ack9owledged
before me this 12 day of AN 20LO
b who is
personally know to in or has produced
as idet t ication.
Sign re of Notary
,Cos/r e/l
Type or Print Name of Notary
Notary Public UV Title
Commission Number
(SEA (SEAL):
Gff�oal SSI OlHcial Seal
Notary P,%
stele f West Nrynia eatery P&e, Slsle of Wxst wginia
Leslie A. Kelly Leslie A. Kelly
NMcelin9Ofiac SUPMY �. NTceling Oelce SUPPry Co.
1420 W"eheet • — 1Q0 Markel SlreM
• Meelig.MMn `+...r WMelin9.MM03
*+�*Nl4SyWtlBVgM(YpgekYWFrta0a2
FOR OFFICE USE ONLY
APPROVED_ DENIED
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE