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NAME:
PAULETTE CHAPMAN
PHONE NUMBER:
586-419-0399
DELIVERY ADDRESS:
726 NETTLES BLVD
CITY/STATE/ZIP:
JENSEN BEACH FL. 34957
COUNTY:
Putnam
SIZE:
14X37
DELIVERY MONTH:
JAN 2021
REPLACING EXISTING HOME:
No
VERTICAL SIDING:
NO
SITE BUILT RAIL:
No
THINGS TO INCLUDE:
AIR CONDITIONER UNIT:
Yes
PLANS AND PERMITS:
Yes
DIRT AND SPREAD:
ON CONCRETE
BLOCK AND ANCHOR HOME:
Yes
PLUMBING:
Yes
INSTALL ELECTRIC SERVICE TO HOME:
Yes
2 SETS OF WOOD STEPS BUILT ON SITE:
Yes
SIDING ENDS OF HOME:
Yes
STANDARD WHITE VERTICAL SKIRTING:
YES
ADDITIONAL
INFORMATION:
Customer stated he is in flood zone and wants a concrete foundation
and have the home built up 8 feet high. Steps will need to be
elevated and stairs built. Customer would like to know if an elevator
system of some sort is available. Thank you.
FACTORY EXPO HOMES
1230 SW 10 STREET
OCALA, EL 34 _ :.
ATTN: DUSTY RHODES
ER iODES@FACTORYEXPCOHOMES.COM
PLEASE HAVE THE FOLLOWING ACKNOWLEDGEMENTS NOTARIZED:
I CERTIFY THAT: (CHECK ONE)
A. ( ) I AM THE OWNER OF RECORD OF THE ABOVE DESCRIBED
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNER/BUILDER.
Olsclosum, Statement, State law requires construction to be done by licensed contractors You have applied for a permit
under an exemption to that lave The exemption allows you, as the ovmer of your property, to act as your own contractor
with certain restrictions even though you do not have a license. You must provide direct, onsite supervision of time
construction yourself. You may build or Improve a one -family or two-family residence or a farm outbuilding. You may also
build or improve a commerdal building, provided your costs do not exceed $75,000, The building or residence must be for
your own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you
have built or substantially improved yourself within 1 year after the construction is complete, the law W11 presume that you
built or substantally improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed
person to act as your contractor or to supervise people wonbrry on your building. It is your responsibility to make sure that
people employed by you have licenses required by state law and by county or munidpal licensing ordinances You may not
delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done.
Any person working on your building who is not licensed must work under your direct supervision and must be employed by
you, which means teat you must deduct F.I.CA. and withholding tax and provide workers' campensaton for that employee,
all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
regulations
B. O I AM I 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 Code and Compiled Laws requires
that this type ofwork be done by a licensed contractor. PLEASE PROVIDE
DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED W 1 THIS APPLICATION IS TRUE AND
0 TO Tiq BPST OF MY KNOWLEDGE.
bWNER/ AGENT SI . URE 'ONTRACTO IGNATURE
STATE OF AA, Mt Chi 15a`r'�
COUNTY OFeT_ *�-. �Ii� , MG c.0,�,'C>
The foregoing instrument was acknowledged
lief re me this _ day ofp.�, 20-
by��who is
ersonp ally know to nd or has produced
tYes( L�C-2�'Ksc'— as identification.
i
t
` ��� U
1A11e�b�r
Type or Prin Name of Notary
STATE OF FLORIDA,
COUNTY OF ST. LUCIE
The foregoing i s ent,v S acknowled ed
befor me this r�'{— a 20
by �I�who is
personally know Jme or has produced
as identification.
ign reofNotary
Type or Print Name
/of Notary
Notary P bl'c Title �;19taRl�li� ✓ Title
—Commission Number (�9h�o( I{ ( Commission Number
V = (SEAL): (SEAL): � Nary public State of Florida
- _ My Commission Expires :� MylC B Baird
GG 281841
December 26, 2021 VIP Expires 12105/2022
FOR OFFICE USE ONLY
APPROVED, DENIED -
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
UPDATED 4/26/2012