HomeMy WebLinkAbout0704-0263-FILLED LAND AFFIDAVIT 5-9-07� C9►u�� �
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SCANNED
BY ST. LUCIE COUNTY
-11c's CoUnVBUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
- 772-462-1553
FILLED LANDS AFFIDAVIT
I, the undersl ned, am the owner of the following described property:
(Tax ID/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In accepting
this Final Development Permit, BP NumberQM'Ak-ItQ ' 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. .
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Property Owner Name Property Owner Signature Date
STATE OF FhOPJaA, COUNTY OF I? 0
ACKNOWLEDGED BEFORE ME THIS DAY OF �a 20 � 7
BY 60l%J�I'G1 C � . �r7Gt dI I WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
�'7
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE �/L COMMISSION NUMBER
COMMONWEALTH OF PENNSYLVANIA
Notadal Seal
Susan A. Ostrowsky, Notary Publio
East Buffalo Twp., Union County
MY Commission Expires Sept.21, 2010
Member, Pennsylvania Association of Notaries
yyi"~SJ`1tz) -- O
CE'' TIFICATION:
This a 'plication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if appl cable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work 'gill be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may b 'required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND IR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structu Ies (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
reside 'ial use.
TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
TO APPLICANT: AS THE APPLICANYTOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
'S AFFIDAVIT: I certify that all the foregoing 'information is accurate and that all work yvill be done in compliance
with all applicable laws regulating construction andAoning. I ,
O R/CONTRACTOR"GNATURE
STATE, OF fL4)P OA
COUN Y OF l/h. a n
i
The for going instrument was acknowledged
before i ie this flay o AV 20�L7by
rr `> -V" wh6 is personally
k own b me or who has produced
/ //e/vt5was identification.
Signatu r
e of Not ry
514 /� .LDS You/`SrC.
Type o rmt Name of Not
Commi Sion No. O (Seal)
SIGNA
STATE OF FLORIDW/�Y//±�.-
COUNTY OF
The foregoing iytrument w knowleUed
fore rqc
his day of!20� by
who is e.�p� rrssonally
kn n to me or who has produced
as identification.
(2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR!
BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
Notarial Seal
Susan A. Ostrowsky, Notary Public
East Buffalo Twp., Union County
My Commission Expires Sept. 21, 2010