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HomeMy WebLinkAboutpermit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /��'^" Date: I`1 Permit Number: �Vll1• CIS)) ® Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓ PERMIT APPLICATION FOR: P'RaP®SED UNPR®VEMENT LOCATIQN: nn Address: 11,90.5- M YR` 16G 199 �OfZT 6� (05 ' /�G 3l,Rgo Legal Description: Property Tax ID#: 5 d 13 — 000 `Z Lot No. Site Plan Name: Block No. 1 - Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED D'E:�SCR�IPTIO.N OF VVOR+K: t 1 n9 b-rA -L 2-70 4601' 0 F- WO I Tf' U J&3-1i- F0Ix9 To '7-�4G I?�A L' CO/% 1�/Lc)oa-ry 6 SEL N%4H MEN INFORMATION: Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors z Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ Utilities: —Sewer _Septic Building Height: Otl1NNER/LE�S�SEE: C®NTRACTOR: Name__cAa- 0(laW5 Name: Address: //,;�05' MY9l1-C P)Z Company: City: NG?--r IP�oi'G[% State: Address: Zip Code: 3((a SS Fax: City: State: Phone No. `J� 5-3,510 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. RM MINIM M 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 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/Le /Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA ` STATE OF FLORIDA Zk COUNTY OF X1,9, �e� COUNTY OF The forgoing in rument was acknowledged before me The forgoing instrument was acknowledged before me this day o 201-1 by this day of 20_ by (Name of person acknowle ng) (Name of person acknowledging) ignature of Notary Public-Stat of Florid a),%'"Q \% t 2 `e ig Notary ) ��" .,° o � i nature of Nota Public-State of Florida ,'nc. e(�•. Personally Known OR P oduced Identification ,,r1.,,•%t'14'ers nally Known OR Produced Identification Type of Identification �Ta � Myc T's' , _ ype of Identification Produced ~�ti�t �°a��, "_ Produced Commission No. earl) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7 4 Planning&Development Services Department Building&Code Regulations © 2300 Virginia Avenue Fort Pierce,Florida 34982 (772),462-1553 OWNERBUILDER 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 licensed to perform the work being done. Your construction must comply with all applicable laws,ordinances,building codes,and zoning regulations. "-Initial t�l-4 I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. _ Initial Ck 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 CF( 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 cost of the license. I Initial C k 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 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 Depart ent to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20_17�. Owner/Builder Sigta 56re STATE OF FLORIDA COUNTY OF '--)L- The oregoing instru ent was acknowledged before me this 3 day of by who is personally known to me,or who has uced FL as identification. r c_ ign ture of Notary Type or Print Name o otary (Seal) Title:Notary Public Commission Number - "uKIA IdfBW�r SLCPDSD Revised 05/15%2014 LASHAHNA UHAPA r 4 � 02 Notary Public- My Co State of Florida mm. Commissiod1#s Dec 20,201B1 Bonded throw9h 177249 National Notary Assn. `I'�f'� ��. ...�-� ..--- �__- w' ;-� �, yi,. a ; ,,�_ fir,...-.1 ����" 1� �/' � ._F•-1, _.... �_ � .4��, _� / _J r°�� �, t1 __,_`;1 } _i_ ..� �:_y� �� ��� -��.a _..�--�---.�-�1,� -''' �.. �� t�y� `��G �,��'J' .� �°. y' �,:a:.A�.. 1 /,__,_. /� G� ,� _' r JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY FILE # 4322954 OR BOOK 4011 PAGE 2723, Recorded 06/23/2017 12:57:50 PM NOTICE OF COMMENCEMENT Permit No, • O S 1 Tax Folio State of Flarida CountyofSt.Lude The undersigned hereby gives notice that improvement will be made to certain real property,and!n accordance with Chapter 713,Flodda statutes, the following information is provided in this Notice of Commencement. Legal Description of Property:(and street address if avagable): �NOIRrJ QWSfL liSffftt'S-uCNr�o-j-BFr[42aoTFMP3lr.(o2N My2ri r- 4772 FoR-r- 196X15 r- 34-c152 X73524. 1a�o:37t6-1h`IS General description of improvement:-0 IF9.S1-ALe- Y60G95 -'O 2164fZ el i—l' Owner information or lessee Information if the Lessee contracted for the improvement: Name G' �. Vi LC,t4is S Address Urso e MY Xi t-E 0�� Interest in property:_OP.)A l62 Name and address of fee simple titleholder(if different from Owner listed above); ContractOeS Name: P2G �1�FY�iS ContractorAddress:,40oC- 0YJ21Zr ri'_ Ao[Zj J= R.9 4W Phone Number.:j 9?s1 3'0 Surety(if applicable,a copy of the payment bond is attached):Amount of bond:S Name and address: Phone number.• Lender Name: Phone Number: Lender's address: Personswlthin the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 1 3(L)(a)7.,Florida Statutes: Name: Phone Number. Address: In addition to himself or herself,Owner designates of to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Phone number of person or entity designated by owner: Expiration date of notice of commencement: (the expiration date may not be before the completion-of construction and final payment to the contractor,but will be 1 year from the date of retarding unless a different date Is specified) WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTSTO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORETHE FIRST INSPECTION.IFYOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Underpenalty of perjury,)declare that I have read the foregoing notice of commencement and that the facts stated thereln are true to the best of my knowledge be lief. L2 (Signature ofOwneroree,orOwners orLessee's AuthorfzedOfficer/Director/Partner/Manager `1p1i,°j El DAtIDflIDCE (Signatory's7itte/Ofrice) Qw•°4%,, 6�� Notary Public.-51111 of flotlda The f egoing inst nt was acknowledged before me this day oC ,Zp y ? Commission N FF 9At tgT �f�a• My Comm.Expires Avg 3,2020 as ( J�n't� tar Name Person Type of authority(e.g.offlcer,trustee) Party on behalf of whom Instrument was exeatied �°°"`'•., Personally kn n_ar produced Identiflcatlon (Signature of Notary Public-Sta of Florida) a' 20 (Print,Type,or Stamp Com ned Name of Notary Pu itS�9 = - Type of Iden1l cation produced STATE OF FLORIDA ST.LUCIE COUNTY THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT C PY OF THE r ORIGINAL JOSE E.SMITH, L g.� -� '• V BY: Deputy Clerk y (a . 2-3. 17 Date'