HomeMy WebLinkAboutVegetation App Pg4 PLEASE HAVE THE FOLLOWING ACKNOWLEDGEMENTS NOTARIZED :
I CERTIFY THAT: (CHECK ONE)
A. ( ) I AM THE 4WhTER vF RECORD OF THE ABOVE DESCRIBED
PROPERTY AND WILL BE CONDUCTING SHE WORK AS OW�rER1i3UILDER.
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 act as your awn contractor with certain restrr"ctions even though you do nQt have a Incense.
You must provide direst, nrrsite supervision of the constt'uction yourself. You may build or improve aone-family or two-family residence or a farm
outbuilding. You may also build or improve a commercial building, provided your costs do not exceed$75,000, The building or residence must 6e for your
own use or occupancy. It may not 6e built or substantially improved for sale or lease, Ifyou sell or lease a building you ha ve built or substantially improved
yourself wiMin 1 year aver 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 or to supervise people working on your building. It is your
responsibility to make sure that people employed by you have Incenses required by state law and by county or municipal licensing ordinances You may
not delegate the responsibility far supemsmg work to a licensed contractor who is not licensed to perform Me work being dine. Any person working on
your building who is not licien.5ed must work under your direct supervision and must be employed by you, which means Ma you must deduct F.I. C.A. and
withholding tax and provide workers' compensation far that employee, all as prescribed by lath! Your construction must comply wilts all applicable laws,
Qrdinant codes, and zoning regulations.
B. I AM NOT THE OWNER OF RECORD OF THE ABQVED
DESCRIBED PROPERTY; HaV4'EVER1 I HAVE AUTHORITY TO ACT A5 AGENT FAR THE OWNER OF
REGARD. (St. Lucie County Code and Compiled Laws requires that this type of ivork be done Icy a licensed
contractor. PLEASE PROVIDE DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH T APPLICATION IS TRUE AND COMPLETE TO
THE BEST OF MY KNOWLEDGE.
OWNER/ AGENT SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORIDA, STATE OF FLORIDA,
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before me this . day of 2Q__,3before me this N -,>� day o��� , 20,-��,
by , who is by . Ms& t1, b%*n R �)ogt �� gq
, who is
personally know to me or has produced personally know to me or has produced
as identification. as identificati on.
Signature of Notary Signature of Ngtary
j�) cz-c� Y\ -yrN 4:SN ,.\-v --r%. jr�-s
Type or Print Name of Notary Type or Print Name of Notary
Notary Public Title Notary Public Title
Commission Number 1�r- �1 b��''� 5 � Commission. Number
(SEAL) .
DEANNA GIVENS
Notary PubItc - State of c..
Cofiff1;55iQ[1 HH 086359
My Comm . Expires fan 28 . 2025
Bonded through National Notary Assr .
FOR 0 CE USE ONLY
APPROVED DENIED
REVIEVVED/ APPROVED BY :
ENVIRONMENTAL RESOURCES DEPARTMENT 1 DATE
4 UPDATED 8128120I 9