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BUILDING PERMIT APPLICATION(Page 2 of 2) <br /> INDIAN RIVER COUNTY/CITY OF VERO BEACH <br /> Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or <br /> installation has commenced prior to the issuance of a permit, and that all work will be performed to meet the <br /> standards of all laws regulating construction, insurance, and worker's compensation. I understand that sub- <br /> contractor affidavits must be obtained for electrical, plumbing, air-conditioning, roofing, insulation, irrigation <br /> systems,wells,or any other work that is allowed to be included in this permit. <br /> Properties on which earth spills or other debris falls shall be cleaned immediately. All streets,sidewalks,and curbs <br /> damaged due to this construction shall be repaired to the satisfaction of the engineering department prior to the <br /> issuance of certificate of completion. <br /> Owner's Affidavit: I certify that all the foregoing information is accurate and that allwork will be done in <br /> compliance with all applicable laws regulating construction and zoning. <br /> WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR <br /> PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT <br /> WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. <br /> And <br /> Signat a of <br /> Date: I� I- Date: <br /> As to Owner: As to Contractor: <br /> State of�� State of <br /> County of County of <br /> The fore oin instrument was acknowledged before me The foregoing instrument was acknowledged before me <br /> this day of 20J'5by this day of ,20 by <br /> - 0 �,., K who is personally who is_personally <br /> M6w�n or h`o_hO produced identification. Type known or who has produced identification. Type <br /> dffrit <br /> ifcial ication produced. identification produced: <br /> Signature of NotaryPublic Official Signature of Notary Public <br /> �.�,�,G 't'(1Gc�P ��GQZ �1 <br /> Notary's Name,Typed,Printed oNotary's Name,Typed,Printed or Stamped <br /> PATRICIA UWE K&ppjQM <br /> Notary Seal NOTARY PUSUC Notary Seal. <br /> STATE OF FLORIDA <br /> Comrr*FPgpM <br /> Eq)Ires&2R/jp+e <br />