HomeMy WebLinkAbout1707-0623 (2) Al!APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
Address: 7 i
Legal Description:
b
Property Tax ID#: -- l ""` � ()Sol' WO,14 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
� E -
Additional work to be pe rmed under this permit–check all that appy:
_Mec anical _Gas Tank Gas Piping _Shutters Windows/Doors r
V Electric Plumbing r'
_ ,_• g Sprinklers _Generator T Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic; Building Height:
Name 9NC4 AN ' o Name:
Address: 1 _ - Company:
City: F4. LAun6'90AL s- State:E Address:
Zip Code:�' �3 I� Fax: City: State:
Phone No. Fax:
E-MailIA64A{.,)A 90AA19�6MM101 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner fisted above) State or County License
If value of construction Is 2500 or more,a RECORDED Notice of Commencement Is required.
Planning&Development Services Department
' NTYBuilding&Code Regulations
D A 2300 Vuginia 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 iconstruction 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 licensedto perform the work being done. Your construction)must comply with all ap e
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 et
the minimum code. Initial
'a 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 liabl e
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
cost,which could include loss of wages during recovery from their injury. Initial 7 ,
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 L of 20 .
Owner/B Idr Signature
STATE OF FLORIDA
COUNTY OF -
The�egoing instrument was acknowledged before me this ayj day of 20�
by who is personally known me,or who has
oduced �� as identification.
Si ature of No ussy ARION y6noi41 papuog'
gn Notary Type or Print Name of Notary ����
Title:No Public 6b M J# olsslwwo�
tart' Commission Number
94OZ'OZ Dap sajldv]uwoo AW
ENJold 10 alels 31l4nd Amo;a ?.
SLCPDSD Revised 05/15/2014 Wtl�9 fd l VN HV.t.:--�
f