HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
kl• i•E�D
MAY 12 2017
BUilding Permit Application
Planning and Development Services PERMHTTiNG
Building 9 and Code Regulation Division St. Lucie COUnty, FL
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y/
PERMIT APPLICATION FOR:
PRCIPOSED INPR� EMf'NT L®CAl'10 n
Address: S c) ! Si / sp
Legal Description: ,�:` r pwv o. - 'c C-
Proert
p Y Tax I D#: (inn Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
MY&OM pmmPw N WORK;
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CONSTRUCTION I'�N�FORM TION:
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r
Cost of Construction: $ Jljo" Utilities: —Sewer —Septic Building Height:
11@04 NIB:IR 101-55 0 1 CONTRN$_0R:
Name Name:
Address:4& clOtl Company:
City: d"' State:_ Address:
Zip Code: Fax: d City: State:
Phone No. 22 Z'Z Zip Code: Fax:
E-Mail: 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.
S:U�PR�LEMENTAL CONSTRIU.CT1®N LLErN Lp►1N IN,F®RMATI�N:
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 the permit 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 another 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF STATE OF FLORIDA
COUNTY OF FLORIDA, „ . A10,1
_, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this AQ- day of rnny 201T by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledgingA A _�'. �_k'
)
(Signature of Notary Pu ic-State of Florida) / (Signature of Notary Public-State of Florida)
in
Personally Known OR Produced Identification
PersonallyKnown OR Produced Identification Y
Type of Identific tion Type of Identification
Produced W C.
)✓ Produced
_ �.� � ,
KAREN S. N =
0. ' ol�hiss n No. (Seal)
Commission No. 7 '101 f Commission ;,, F 115637
r a= My Commissior Ex fres
P
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
f
VQ,V- a r � � �� �o t has been advised NO structures DAY
�t
6
can be erePERI Acted within any easement or I't-C(,,G
St. Lucie County, FL
right of way unless otherwise approved.
Applicant Initials_
1
' CEJ
r
11.
5'
PACKING LIST
From: Ship To: Bill To: Account: 000102
INTERNATIONAL WHOLESALE TILE ERIC TANCRELL CERAMIC TILE CENTER
3500 SW 42ND AVE I P.O. BOX 877
PALM CITY_ FL 349900000 PALM CITY, FL 349900000 PALM CITY, FL 349910000
772-223-5151 772-223-9744
i
Order Date: 5/10/171 Ship Via: Truck Route: CUST P0:#:MOTHER HOUSE JOB#/NAME: REFERENCE#:
Date Required: 5/11/171 CUSTOMER PICK I Terms: C.O.D. /ADDITIONAL 1292508
THURSDAY MJ
I
CUST PO#: MOTHER HOUSE Order#: 243660
Item# lCust Item#lSerial#1 Description I QTY U/Ml Packaging
*** COD ***
0001 SPECIAL PRICE PER STEPAHNIE
PRXSMMEVG18 D18 CREAM DURACOLOR GROUT PAREX 1.00 BG 1 BG
FLOOR WALL 25 LB BAG
ACPFLEX1000W FLEX 1000 ULTRA WHITE 50LBABEG000 5.00 BG 5 BG
POLYMER MODIFIED THINSET
TASTSONCR20 ONYX STONE CREAM 20X20 240V 301.28 SF 14 CN
243660/0030
POD
COMMENTS
*** C.O.D. *** COLLECT $ 462.80
Total: 0 CT 6 BG 14 CN
Order Weight: 1,164 LBS
FOB: WAREHOUSE
Signed By:
I -
IWT -5/11/17 10:48 Page 1
—,Ua i
Planning&Development Services Department
COUNTY Building&Code Regulations
2380 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-ownei-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 licensed to perform the work being done. Your construction must comply with all applicable
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 ha eet
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 Iicense,I may be responsible and Ii51
cost 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 cal
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 the building
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
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
_ day of of 20111
O ' r/Builder Signature
STATE OF FLO DA
COUNTY OF; 1
The regoing i ent was acknowledged before me this day of may ,20 �r� ,
by �I031 it" who is personally known �- to me,or-who has
produced as identification.
�Signat�ureofN�otary tTypePrint Name of Not
Title:Notary Public Commission Number ;�Q;:a� A R E LF S E N
Commis5637
My Compires
SLCPDSD Revised 05/15/2014 Jun8
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