HomeMy WebLinkAboutSIGNED PAPPERWORKI
I CERTIFY THAT: (CHECK ONE) "" raxmnu:
A. () I AM THE OWNER OF RECORD OF THE ABOVE DESCRIBED
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNER/BUILDER.
Dlsdasure Stafemenf.• Stale lawrequl2smnsGu7lon to N done by/ kensedmnbactors You have appliedfara pem/t under
an exemption M that(aw. The examptian alaxayou, as L4e ownerorJvUrpmpe*, to actasyourown mnbadartWO certila
you
inay bulldu augh Jau do nothaua a b'c2rue YW must pmNde dlreer, onslte svpeivls/mn ofdre rnnsbtnctian yaws&f.
mmmertla/ bW/d prove a ene-famr7y Of fvio-famNy resar a farm autburftzrg. You may a6z; bold or h74=ve a
/m,7, provided your cases ab not exceed $75,75ougfQ lyre bufdmg or resfdertce must be for your own use or
oavpancy, It may notbe bull[ arsnhstandally lmyavzd for sale or lease, if you sell or lease a bufdurg you have bultt or
srrbstandally Improved yourself w1drM I year aRer bye mr[strucb'on Ls mmpk_te, the law w/f pnsume drat you buff or
substandal/ylmpmved?forsale arlease, tvhioYts a Wala[ion offt exempdon. you maynothNe an aR/lfeA;ad pe yM to act
asyvurtmbaetorarta sr�ervia peapie+wddrpon yourbW/dog. It Isyan-respanst'b/flyto mahestue thatpeapte emp•'nJVd Gy you hatre licenses raqufad bl'sate !ew and by munly or mtmlr�731 hhagskG ardaramxm You may not delegate Me
responsl6;' farsvpervtn'ng wont m a /ia»sad conbacior who (s gat #MWed to perform the M& bang Cane Anyp-mn
vet idng on Jwurbultong who is Hall/cacsed must wa7t under yaurdrectsupe msan andm6t bu emp/ayc by Jet y wmdi
means deaf you must deduct FJ.C.A, and tncthheld/ng tax and pm tide woofers' campa isaffm for that enp/eyee, al/ as
pmsotbedbylaw. YourcarsbucNon must mrnp/ytatldr a//app/icah/e laws, aroinances, bolding rode£ andmn/ng Mg,&Wa2; B. () I AM NOT THE OWNER OF RECORD OF THE ABOVED
DESCRIBED PROPERTY; HOWEVER, I HAVE AUTHORITY TO ACT AS AGENT
FOR THE OWNER OF RECORD. (SL Lucie Cuungr Cade and Compiled Lmvs requires
fhaflhts type ojivorkhe done k , a licensed wmrucfor. PLEASE PROVIDE
DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH THIS APPLICATION !S TRUE AND
COMPLETE TO THE BEST pF My KNOWLEDGE, �y
OrAUEN SI NAG REJI � 4F" 'L�/��
CONTRACTORSiGNATURE
STATE OF FLORIDA,
COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged
before me this 9 day of 'TOM , 2015
by l.e G Acaron who is
parsaneflV know to me or has produced
as identification.
Signature of Notary
e
1466+ na- ma�Sha i (
Type or Print Name of Notary
Notary Public Title
'�sicn N mbar99M
MhRSH4LLn€ EE133079ruary 6, 209E
tln YevxwEpp54HOfa
STATE OF FLORIDA,
COUNTY OF ST, LUCIE
The foregoing Jtrument w knowjpdged
ns
be a i' a' day of 22
by who is
Personally know to me or has produced
as identification.
or Print Name
SCANNEL
BY
St. Lucie Col
Notary Public Title
Commission Nu
(SEAL): s�eYuvaf�R^I9nd.42tth;,U41 r.�a:__....
f14' •�;
:t�,;• y �-''..
L40Z'LtN:�p:5il31d03
OL04l6 jdBNDISSIVt6Yoo AYV
,..,V
,
wooS3oNtlu:i
rttb}ttrttrtptttpb}rtbptt}rtrtktrttbttt}ptrtrtrtbtYtpprttbppdtbtt}}rti }prttrttkrt}t}}}btttbt}}tttbttp
nrPsovEn_ neN[En` FOR OFFICE USE ONLY
REVIEWED/APPROVED BV:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
UPDATED 512014