HomeMy WebLinkAboutACKNOWLEDGEMENTPLEASE HAVE THE FOLLOWING ACKNOWLEDGEMENTS NOTARIZED,
I CERTIFY THAT: (CHECK ONE) %'q%)
A. I AM THE OWNER OF RECORD OF THE ABOVE DESCRIBED k �)
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNER/BUILDER. 061/6�
Disclosure Statement: State law requires construction to be done by licensed contractors. You haw applied for a permit C0497j,
under an exemptnin to that law. The exemption allows you, as the owner of your prqoeri)� to act as your am contractor
with certain �Wcftons even though you do not have a license. You must provide diect, onsite supervision of the
construction yourself You may build or improve a one -family or two-famw residence of 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 be for
your own use or occupancy. It may not be built or subsianbrally improved for sale or lease. If you sell or lease a building you
have built � substanVally improved yourself within I year after the carrustuctan is complek the law wil presume that you
built or substanually improved it for sale or )easg, which is a violation of this exemption. You may not him an unlicensed
person to act as your contractor or to supervise pecple wondrg on your building. It is Your responsibility to make sure that
pei;lile employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not
delegate the responsibility for supervising work to a licensed contractor who is not licensed to pefform the work being done
Any person workny on your building who s not licensed must work under your direct superksion and must be employed by
you, which means dial you must deduct F. L CA. and Wthholding tax and proWde Wo4ers'compensatim for that emaloyee,
all as presmbed by 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
DE8CRIBED PROPERTY; HOWEVER, I HAVE AUTH6RITY TO ACT AS AGENT
FOR THE OWNER OF RECORD. (St. Lucie County Code and Compiled Laws requires
that this type ofwork be done by a licensed contractor. PLEASEPROVIDE
DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH THIS APPLICATION IS TRUE AND
COMPLETE TO THE BOT OF MY KNOWLEDG9.--�
'140. AWF-iW—
`0�13�XTU" CONTRACT R SIGNATURE
STATE OF FLORIDA
COUNTY GFST. ttl�l <;�mOv�q
The foregoing instrument was acknowledged
before me this 93 da of 20 ol
b iffiam Brya—n Ag"amis, IS, who is
personally know to me or has produced
as identification -
STATE OF FLORIDA
COUNTYCW- m- tzvp-
The foregoing instrument was acknowledged
bef
,p,�em tl�*Aag&��201%
,, 111a;n
b Lok�pu *ho is
personally know to me or has produced
SHELLEY A. SEPULVEDA SHELLEYA. SEPULVEDA
Type or Print Name of Notary Type or Print Name of Notary
Notary Public Title Notary Public — Title
C-A�262cr74 Commisi-sion —Number C42&=4 Commission Number
(SEAL): SHELLEYA. SEPULVEDA
(SEAL): ..... LVEDA
SHELLEYA, SEPU
My COMMISSION # GG 262074 MYCOMMISSION#G 262074
EXPIRES: January 25,2023
& EXPIRES: January 26,2023
,15F 8ondodThruN*twPubHGUrAQrxftQf0
Bonded ;T61,u Notary NMI Underffbm
P.QQ0-EFIG-EjQ$
APPROVED- DENIED -
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT DATE
112
UPDATED 10,'21/2014