HomeMy WebLinkAboutlipp veg 2PLEASE 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.
Disclosure Statement State law requires construction to be done by licensed contractors. You have applied for a permit
under an exemption to that law. The exemption allows you, as the owner of your property, to ad as your own contractor
with certain restrictions even though you do not have a license. You must provide direct, onsite supervision of the
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 commercial building, provided your casts 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 aRer the construction is complete, the law will presume that you
built or substantially 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 of to supervise people working 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 municipal kenning 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 y r building who is not licensed must work under your direct supervision and must be employed by
you, which means tha ou must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee,
all as prescribed law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
regulations.
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 Code and Compiled Laws requires
that this type of work be done by a licensed contractor. PLEASE PROVIDE
DOCUMENTATION). %%%% jj��
I CERTIFY THAT ALL INFORMATION SUBMITTEDr�ITIJf]�IS APPLICATION IS TRUE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE. �� �� �M// fl�Il
OWNER/ AGENT SIGNATURE QONTR'�1C 'OR SIGNATURE
STATE OF FLORIDA, STATE OF FLORIDA,
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged The foregoing ins ent w. acknowledged
before me this _ day of 20_, befo me th' r day of 20
by who is by 1 who is
personally know to me or has produced personally know o me or has p duced
as identification. I %a /--, n . as identification
( A
Signature of Notary Ig a c tary
i V! 7
Type or Print Name of Notary Type or Print Name of Notry
Notary Public Title o Cublic Title
Commission Number C2 (l Commission Number
(SEAL): (SEAL
�Y.� ,�Erin L Chavez
r% Comm.# G952777
3 Expires: Jan 29, Z024
`-� Bonded Thru Aaron Notary
FOR OFFICE USE ONLY
APPROVED_ DENIED_
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
d UPDATED 10/21/2014