HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /.`� 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: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
P# SDAPRO�VEi �1.00A1"f3N
Address: 3
Legal Description: U m
Property Tax ID#: c/03 5-0 0 3 h j�00 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit—C ec 2 t at 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:
Cost of Construction: $ 7P P, Utilities: _Sewer _Septics Building Height:
QWNRf LE SEE: F CONTRAGTQR
Name �L41A2 07 Y Name:
Address: ?Va' zv,�- Company:
City: �,� i2G State: Address:
Zip Code: -3/1 P2-) Fax: City: State:
Phone No. 7"7 L Y,/,'<- .Zi� G' 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,.
SUPPLEIVIENTAL,CONSTRUCTION LIEN LAW INFORMATION , ,
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 FLORIDA STATE OF FLORIDA
COUNTY OF ���� COUNTY OF
The f o'ng instrument was a knowledge before me The forgoing instrument was acknowledged before me
this day of 20� by this day of 20_ by
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica f Type of Identification
Produced .L— Produced
ANGELA M HUFF
Notary Public-State of Florida
(Signatu� rt 4 �oetairy Al3Vss.34Af6 a (Signature o o ry Public-State of Florida)
0 .. My Gomm.Expires May 27,201
"i ° ° Bonded through National Notary s .
Commission No: _ . .- e`� Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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Planning&Development Service's Department
COUNTY 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 licensed to perform the work being done:.Your construction must comply with all applicable
laws,ordinances,building codes,and zoning regulations. Initials'
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I understand that the building official and inspectors are not there to design or give advice on how/to meet ,
the minimum code. Initial K/
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 C�
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 The responsible and liable for the
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 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.
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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,lieported by the Building and
Z Department to the Florida State Department of Professional Regulation. Sipped and acknowledged on this
day of of 20 C7.
Owner/Builder Signature
STATE OF FLORIDA
COUNTY OF '=%-+- ��G� �
Th f e oing ins net acknowledged before me this. ) Z'Sj day of ,20
by who is personally known to me,or who has
produced as identification.
Si a of Not ype or Print Na a of otary -(Seal)
Title:Notary Pu c Commission ber , -
"""".� ANGELA M HUFF
♦PRY PUg
SLCPDSD Revised 05/15/2014 �r°.,�4`� Notary Public-State of Florida
_•«`. :•; Commission#FF 234730
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ORO My Comm.Expires May 27,2015 I
��''°� `+�'` Bonded through National Notary Asen a'