HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABkf INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7Date: Permit Number:
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---� Building Permit Application
Planning and Development Services
Building and Code Regulation`Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (7;72) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROP®SE,,/D UNPROUESMENT L®CATION:
Address: Z---L�iR-�'���
T79S
Legal Description:
Property Tax ID #: "'t J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET I. ED DE�SC//
CONSTRUCTION 1=N'FOR!MATtON:
ditional work to be performed under this permit —check a t at app y:
_Mechanical _ Gas Tank _ Gas Piping 'Shutters _ Windows/Doors
✓Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: r Sq. Ft. of First,F,loor:
Cost of Construction: $ (off • /_ Utilities: —Sewer _ Septic Building Height:
01NNER/LE-SASE:
CON RAC 'OR•
Name:
Name� liIJ-p—
Address: 4.
City: %�rL'C-T% State: >
Company:
Address:
Zip Code: 37'�f Fax:
City: State:
Phone No. 772- 0&5 7 % �!
Zip Code: Fax:
E-Mail:��2
Phone No
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ZVC*=@N8=-TR1UCT1@ N LfEN LAW INF®RMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to anot4er non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work mr-rPrording vour Notice of Commencement.
f
llgatur�Owner/ Lessee/Contractor as nt for Owner
Signature of Contractor/License Holder
STATEFLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f rgoing instrumen as acknowledged efore me
The forgoing instrument was acknowledged before me
this day of 20_ by
this ay of y
n7o,
(e gin)
Name of person ackowlg
(Name of person acknowledging
LA)
(Signature of Nota y ublic- StateofFlorida)
gnature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of I
Type of Identification
A I A M HUFF
Produce" �•`�P"Y a' Florldfi ��
Produced
_• . » •; Commisslon # FF 2'34739
Commis oxn *�P: lr05May :��r•;
Commission No. (Seal)
e;
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
r
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even
though you do not have a license. You must provide direct, on-site supervision of the construction yourself You
may build or improve farm outbuildings, a one -family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people 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 Iicensed to perform the work being done. Your construction must comply with all a plic Ie
laws, ordinances, building codes, and zoning regulations. - Initial
I understand that the building official and inspectors are not there to design or give advice on how to m t
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable for the
cast of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical
cost, which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection, an owner must personally appear and sign thiZilding
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zoni g Departme t to the lorida State Department of Professional Regulation. Signed and acknowledged on this
-� day of �,A� of 20.
erBui r Signature
STATE OF FLORI A�-�--
COUNTY OF `/1L-.
Thregoing instrume t was ackno edged before me this i day of , 20
_t�]
by' (r'1 who is personally known to me, or who has
duced as identification.
Signature of o ary pe or Print a e f Notary (Seal)
Title: Notary lic Commission Num r
ANGELA M HUFF
SLCPDSD Revised 05/1512014 OpV 1p ,l fi
��;_`„�; os� Notary Public -State of Florida
•: Commission # FF 234730
Po; My Comm. Expires May 27.2018
Bonded through National Notary Assn.`