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INDIAN RIVER COUNTY/CITY OF VERO BEACH <br />BUILDING DIVISION <br />1801 27th Street, Vero Beach, FL 32960 772 266-1260 <br />(No Fee) <br />Roofing Contractor: <br />DBA: License Holders Name: <br />State License Number: Comp Card Number: <br />Gas Contractor: <br />DBA: License Holders Name: <br />State License Number: Comp Card Number: <br />I certify that all the foregoing information is accurate and that all work will be conducted and completed in <br />compliance with all applicable laws regulating construction and zoning. This structure will not be utilized for <br />habitation or as a dwelling. <br />(Owner's Signature) (Printed Name) <br />State of <br />County of <br />Sworn to and Subscribed before me, the Day of , 20 by <br />who is personally known to me or has produced <br />as identification. <br />(Type of Identification) <br />Signature of Notary Public Print, Type or Stamp of Notary <br />Notes: <br />1. *To qualify as an owner/builder, the owner of the property must personally appear at the Building Division and sign this application. (FS <br />§489.103.7) <br />2. Change of Use or Occupancy may require after the fact building permits with demonstrated code compliance including, but not limited to, <br />destructive testing and inspections. <br />3. If requested by the applicant, plan review and inspections will be completed upon approval of a permit application and payment of <br />required fees creating a permanent record of the construction completed for future use. <br />4. Construction Industry Licensing Laws, Mechanic's Lien Law, and Insurance Requirements <br />There are no exemptions from state and county construction industry licensing law, mechanic's lien law, insurance requirements and <br />worker's compensation law. <br />Planning Division Building Division <br />Approved ❑ Approved: ❑ <br />Disapproved: ❑ Disapproved: ❑ <br />Reason: Reason: <br />Reviewed By: Reviewed By: <br />Date: Date: <br />167 <br />