HomeMy WebLinkAboutNOC 2-1-18r I CERTIFY T: (CHECK ENE) MAN N b
A. ( I AM THE OWNER OF RECORD OF THE ABOVE DESCRIBED BY
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNER/BUILDER. � �'� CountyDisclosure Statement.• State law requires constrvOon to be done by licensed contractors You have applied for a
under an exemption to mat law. The exemption allows you, as the owner of your property, to act as your own contractor
with certain restrictions even though you do not have a license. You must provide died 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 bullding, 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 orlsaw. If you sell or lease a building you
have built or substantially improved yourself within 1 year afier 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 buildng. 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 dre 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 that you must deduct F.I.CA. and wiifiholding tax and provide workers' compensation for that employee,
all as prescribed bylaw. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
regulations
B. () LAM 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).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH THIS APPLICATION IS TRUE AND
COMPWN TO THE BES3,0FW KNOWLEDGE.
1 PRECEIVED
GENT SIG CdAT1NXT& GNATURE
STATE OF FLORIDA, STATE OF FLORIDA, F E B 01 2018
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The foregoing instrument was ulmowledged The foregoing instrument was acknowledg dST. Lucie County, Permitting
before a this da of �: 20 befog e. 's day of 20/W
by oergqax V ��� who is by,t�_ who is
perso all. tUnow to me r has produced persona -IN know tom roe has produced
. /1/D..,✓' as identification. �/�!/�as identification.
Type or Print Name of Notary Type or Print Name of Notary
t Notary Public Title
w NWary Public St f $ on Fumber
Feeder nrituion GG OST655 JV NWary Public State d Florlde
MY
a o9t2812021 (SEAL): Frederick E Adams
pimy e, wdij Eden 0302012021 087855
FOR OFFICE USE ONLX
APPROVED DENIED
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
UPDATED 10/21/2014
OWNER INFORMATION
NAME:
ADDRESS: -
CITY: l - STATE: �% ZIP:
PHONE (DAYTIME): (_� Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: /� �'-% 4-1- ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME: �� z
ADDRESS: / //%S�i /11��:►-,� �1�+a.,a �� ' =y
STATE: `�/..
PHONE (DAYTIME): Cage FAX NO. Email
ZIP:�Ir�
r
ARCHIT/ENGINEER:
ADDRESS:
CITY: STATE: ZIP: _
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY: i.
STATE:
STATE:
ZIP:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.