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HomeMy WebLinkAboutBuilding Permit Application (2) Sl�!PPLEMENT=1100IM, 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. Iig a uEre of Owner/Lessee/Contractor as Agent fo Owner Signat r o ontractor icense Holder STA OF FLORIDA STATE OF FLORIDA COUNTY OF ' ,e�, COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of OCk 20_0by this_< day of t 20n by f -7�-, Lill L6 Nam o person maTing statement. Name of persIff ing statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifi�a4oType of IdentificatiTZ, aw Pr edProduced (Si nat re of Notary Public-State o lorida) (Signature of Notary PTbf`f&'-- �t­6f-Floridal) - ` :�UPR�f'LB��, LASHAHNA IN(iIIAA� Commission No. Seal) mmission No. @ Notary %.SP rr�a,, LASHAHNA Ihf(ii zN 4 ;My Com .Expires Doc 20,201® Notary Public-State ra!flori . �q °¢°;� Commission#FF 177249 OF Fl _e roughlationalRbtaryAssn. REVIEWS FRONT Iii°N(� Co ms� r �7�q PLANS VEGETATION SEATURTL ANGR `�i1RdFrI f r COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 8/2/17 Planning&Development Services Department O ;, Building&Code Regulations 0 A, o „ 2300 Virginia Avenue rFort Pierce,Florida 34982 l (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 wit all i able laws,ordinances,building codes,and zoning regulations. Ini I understand that the building official and inspectors are not there to design or give advice eet the minimum code. Ini ' I understand that as an owner-builder that any contract disputes with sub-contractors and I mu be handled in a civil court with the advice of an attorney. This department will not mitigate any contract dispute . Init I understand that if I compensate any person or company for work performed they are re ed to be licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible d liab o the cost of the license. In ' 1 I understand that if any person that is unlicensed and uninsured gets injured on my construction pro a t- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and ated UI cost,which could include loss of wages during recovery from their injury. Initial— To n ITo qualify for this exemption under this subsection, an owner must personally appear and sign th 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 ny violation of the terms of the owner/builder exemption shall be reported by the Building and ing Depa me t Florida Separtment of Professional Regulation. Signed and a nowledged on this day o of 20 rT O erBuilder Signature STATE OF FLQEJPjk COUNTY OF The regoing instrument was acknowledged before me this day of 20 n , by who is personally known to me,or who has du ed I Q td;, as identification. L SHAHNA INGRAIN C2ig atureao'�IN:otary Type or Print Name of otary °, =;' N+� g}��ublic-State of Florida Title:Notary Public Commission Number _ « �; My Comm.Expires Dec 20,201® ;' CWrlmiscion FF 177249 SLCPDSD Revised 05/15/2014 YQ NatlOn�l Notary A®Sn.