HomeMy WebLinkAboutPSL OWNERS AFFIDAVITDocuSign Envelope ID: CAE78E7F-D6F3-4E18-A20A-'V-..' I .7A8FE176
City of Port St. Lucie Building Department
Property Owner's Affidavit For Owners of Prop(rty RECEIVED
Who Are Contracting To Have a DweRing Constructed AUG 0 a ,-,g
Name of Owners: CHRISTOPHER M. TARABA- -ST. Lucle County, Perrnittimo-
Owner's Current Address: 672 SW MCCALL ROAD
Street
PORT SAINT LUCIE, F 34953
city State Zip
Address of Property 0 RIVERBEND TER, PORT SAINT LUCIE 34953
Legal Description BAY ST LUCIE LOT 2 (MAP 44/22N)
Parcel ID (if available)
Name of Contractor
4422-502-0006-000-1
Synergy Homes, LLC
Address of Contractor 1610 Yarmouth AVE. Wellington, FL 33414-8995
Contractor License No. CBC 1254289 14138
State of Fl. Lic # City of PSI #
SCANNED
BY
StLuciecounb/
We (I), affirm that we, (I), own the above property and have contracted with, and fully
authorize the above contractor to apply for and obtain all required building pennit(s).
DocuSlaned by:
(MVPR-er At. 11969
TlEa@0676—flowner
Signature of Owner
Sworn and Subscribed before me this&f� day of &Q44-20_&.
The above is personally known to me or has produced NV �J
As identification. Number— N L+ Exp. Date J\11A
,-5;- A,--�
Witness ��kA&:::�:—Notary
Signatua State of
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