HomeMy WebLinkAboutFilled lands affidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
7312 Commercial Circle, FT. Pierce FL 34951 ID: 1335-801-0040-000/3
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 2103-0026 , I acknowledge
that as owner of the above described properly, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
i
Prop er Name (Please Print) 9-
Sign tore Date
STATE OF FLORIDA, COUNTY OF w f
ACKNOWLEDGED BEFORE ME THIS DAY OF &J_-0—r—C `' 20 a I
BY � � f F' C� WHO IS jOERSONALLY KNOWN ME Q OR WHO HAS
PRODUCED
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
(SEAL)
NANCYHERRERA
Notary Public -State of Florida
Commission 41 GG 189748
My Comm. Expires Feb 25, 2022
Bonded through National Notary Assn.
PLEASE H 4VE THE FL.UWING ACKNOWLFi3(' ...NTS NnT ZED
T CERTIFY THAT (CHECK ONE)
A. ! ) I AM THE OWNER OF RECORD OF THE ABOUT DESCRIBED
PROPERTY AND WILL BE CONDUCTING TUE WORK AS OIVNETLBUILDER.
Disdosxrre Statement. State law requires construcborr to be done by licensed contractors You have amliedfora permit under an exemption to that taw.
The exemption allows you, as the owner of your property, to act as your own contractor with cettain rest xt7bns even though you do not have a 11cense.
You must provide direct, onsite supervasion of the canst7utKlatt yourself, You may build or improve a one -family or two-family tasidence or a farm
outbur
rng You Maya/so build or improve a commercial building, provided your costs do not exceed P5,000. The building or residence must be for your
vwn use vroccupancy, It maynotbe buritorsubstantrallyimprvvedfor sale orleast Ifyou.setlariease a 6ulldirt t yr7u havebuiltor�ubstantiallyimorryour
yourself wrthta 1 year a $er the construction rs complete, the law wi// presume that you !wilt or substantia/lY improved it for sate or leas, which is a
v/otation of th/s exemption. You may not hire an unlicensed person to act as
respensib/lily to make sure that people em /o ed b Y�+r rntrador or to supervise People Woking on your building_ It is ye�ur
not delegate the re P y Y You have licenses required bystate Jaw and by county or municipal licensing oroinarues youmay
sponsicen-& far supervising mrk to a'tenser! contractor who rs not licerssed to perform the work being done. Any Person working on
your building who Is not /!tensed must work tinder your direct supervision and roust be employed by you, w/rrch means #rat you must deduct f.I. CA, and
vvlthhold/ng tax and provide and
zo rs' compensation for Mat ernptoyee, all as prescribed by law. Your construction Must at YOU + all Uct i cI C id ttS,
ordinances, t7dtnd codes, and rers' c mperttons
B. I AM NOT THE OWNER OF RECORD OF THE ABOVED
DESCRIBED PROPERTY; HOWEVER, I HAVE AUTHORITY TO ACT AS AGENT FOR THE OWNER OF
RECORD. (St. Lucie County Cade and Compiled Lrnvs requires that this t1Pe of -work be done by a licensed
contractor. PLEASE PROVIDE DOCUMENTATION1
I T Y THAT ALL INFOR I N SUBI;'IITTED WITH T
E T. OF M O ED E. LICATIO RUE AND COMPLETE TO
Vi7NER/ AGENTS N C TRACTOR SI NA E
STATE OF FLORIDA,
COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged
before me this i .) h day of "Q!`Ch, 24
by 1�C� ( _.� k, FC who is
know to or has produced
as identification.
Signat&6 of Ncitiry
Type or Print Name of Notary
Notary Public Title P7
C7 C-2 / 09 7�j A Commission Number
STATE OF FLORID<
COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged
before ine this day of �1QMC h, MA
by 1 { I IlaQ t2 VY l0 tc1C , who is
personally kno!0 to me or has produced
as identification.
1�
Signature of Notary
_-Allison,
Type or Print Name of Notary
Notary Public Title
C-At,_Commission Number
(SEAL): (SEAL): 90%
vvwwwNANCY NERRERA NDior Public State of Florida
Notary Public - State of Florida t lOWn K Downie
Commission x GG 189748 Hh Commission GG 952547
My Comm. Expires Feb 25, 2022 bzr2Br2(}2a
6®nded through National Notary Assn,
APPROVED DENIED FOR OFFICE USE ONLY
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
UPDATED 8/29/2019