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HomeMy WebLinkAboutFilled Lands AffidavitST. LUCIE COUNTY J1 BUILDING & ZONING 2300 VIRGWIAAVENUE ° FORT PIERCE. FL 349825652 z F<OR►�p' 561-462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property: 2.532- 5nv - 0023 - Lwu— 2 1W,33 Wglers,,j,,5 btmr) (Tax ID/Legal descnplion/Address) for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number 'r=� , I acknowledge that as owner of the above described property, 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. Property Owner Name Property Owner Signature Date STATE OF FLORIDA. COUNTY OF Iq ACKNOWLEDGED cBEFORE ME THIS DAY OF , 20 U ,/ BY I WHOIS EROY E OR WHO HAS PRODUCED AS IDENTIFICATION. G��/l�--Gam✓`-��� SIGNATURE OF NOTARY NOTARY PUBLIC TITLE M /OWN F- //hb Q0Hy TYPE OR PRINT NAME OF NOTARY (SEAL) COMMISSION NUMBER �x Marianne Murphy My Commission DD250717 Expltes December 25 2007 St. Lucie County LSE c h' Building & Zoning . FLOR1�4 • BUMDING PERMIT SUB=CONTRACTOR SUMMARY AOL /"-yq" A1�79� will be using the following sub -contractors for the (Company/Individual lName) project located at I '�1/A7'�+'s (Street adlkds or Prope ty Tax ID f It is understood that if there is any change of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical Plumbing n HVAC/ Mechanical nn kLA1.���� Roofing a 014 �S^ a�C P3 Gas DFFICE USE ONLY: PERMIT PSUEDATE: NUMBER: a • �y ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number. 3 © S7 State of Florida Certification Number (if appiicabie). �30 i 3 :1_0 0 E�- 2c,a ks l c'r!Zt c i N C have agreed to be the (Company Name/Individual Name) sub -contractor for Arm, 0/. 96u� (Type of Trade) (Primary Contractor) for the project located at WGAL (Project Street ID #) It is understood that, if there. is -any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGNATURES ARE REQUIRED SIGNATURE PRINT NAME 5-- t ('o-0-7- DATE Business Name: ,F6Tia (Z J Q pdCC5 L� C;` l 2(C j o-c C Address: .2— (e 3-4 �'(L o P t Ct( F P, 5-T- c R_ c c City/State/Zip: S - (-, , F L 3 (s,_ R5 a Phone: T o� (�4 �5 r � t email: ga:TC O l O (D �--`n C LP" (.9 OFFICE USE ONLY: • C ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT FIOR'Np' ,. BUILDING PERNIIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: Z 01 Z 1 State of Florida Certification Number (if appiicabie): Cz6G I ±Z5 E l P PLA-Ann6nci c,,2monq have agreed to be the (Company Name/indi id al Name) M P sub -contractor for .. G �— (Type of Trade) T— (Primary Contractor) for the project located at 3 "AaMq 4 (Project Street Address o r perry Tax # ) It is understood that, if there is any change of status regarding our. participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice_ (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGirATLiRES ARE REQUIRED SIGNATURE PRINTNA DATE Business Name: Address: City/State/Zip: Phone: 1wild mom6=0-- �N--- OFFICE USE ONLY: tea -0'-I-D `7 DATE I f y'd JU tj 0 • ST. I UC +' COUNTY PUBLIC 'NOOKS BUILDING & ZONING DEPARTMENT BV LLING IPERMrf SUIT-COX:'"RACTOR AGREE VI NT St. Lucie County Contractor Certification Nu faber. . ��o� 695- State of Florida Certification Number (if upplicabte): ..... I lj q q _ n r, .. (Company Name) have agreed to be the -�..VIU-1 sub-cnr, "etor for _SoGL_bG�Q.1�L� (Type of Trade) (Primary Contractor) for the project located at ff3 x�(e';' (Project titreet Addze:,,s or #1 It is understood that, if there is any cl-Aange of statics regarding our participation wiL'z the HAaE i y - l V&+� `mess io.h�o projects Pwrli1°in, J diately-Mvise the-Buildirzg and°Zoriirzg i?epar:merzt c� �t Fi.u�ze County b;�personailyfilY�7gaT�h3zlge �i'.!Gi7ntractor-nv!ice..{Forin:,SI_CCL�v..., ..:` Ivo. QUg-C4) 'BUSINESS QUALIFIER(Na: ie of t:�e Irsdivid�zal shover, Gn the Contractor°.s Li:;ensz:; ZATURE i'- 'Business Name: Address: chylstate"7* Phone: 1311. d L. • ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPAR17YMNT BUMDING PERMIT SUB -CONTRACTOR AGREEMENT St Lucie County Contractor Certification Number: nn2 C)L � 5 State of Florida Certification Number (If applicable): L� C � a � ) I tLei WAsk have agreed to be the ((Company Name/Individual Name sub -contractor for (Type of e) (Primary Contractor for the project located at �33 .r a (Project Street Address or Prope Tax ID ##) It is understood that, if there is any change of status regarding our. participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice_ (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGMAL SIGNATURES ARE REOUIRED IG TURF PRINT NAME DATE Business Name: Address: (ci2lo �� Dave--br,-I- City/state/Zip: Part S: ) oc;: e Z I%(- 3`I Tt 3.- 1 Phone: �'n 2-) 337 ' 5 email: W-Alk 902f 0— S OFFICE USE ONLY: