HomeMy WebLinkAboutBuilding Permit ApplicationAll 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 E
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resyldential
PERMIT APPLICATION FOR:
'RP}PC}S Q iN.PROUQ,_ ,T LOCATMC N
h'-'10Ca Su wS(-7 15Lk/10 t t
Address: r�� {l2Ctr� '3 (� �Z
Legal Description: II
�I
Property Tax ID #: l9 t' Q LA 0 LA L90 ce-3 i Lot Np.
Site Plan Name: I i Block No.
i
Project Name: +�
Setbacks Front Back: Right Side: Left Side: i{
Aaaitionai worK to oe pertormea unser tnis
Mechanical Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ �
permit — cnec
Gas Piping
_ Sprinklers
K aii tnat apply: q
li
Shutters ii _ Windows/
.I
_ Generator y Roof
i
Sq. Ft. of First Floor: 11
Utilities: _ Sewer _ Septic Building Height:
Doors
Pitch
Name Oaya� (I-6-Lko Name:
Address: ED562
ygs,!✓J Company:
City: (& w State: L Address:
,EI
Zip Code: y 0((27_ Fax: City: State:
Phone No. 127— — �� �� �'l 007— Zip Code: ! Fax:
E -Mail: I','Qllo W4 C, Phone No !�
Fill in fee simple Title Holder on next page ( if different E -Mail Z II
from the Owner listed above) State or ounty License !�
If value of construction is 2500 or more, a RECORDED Notice of Commyficement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 failur 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 i tend to obtain financing, consult with lender or an attorney before
commencing work or recording you Notice of Commencement.
Rev. 8/2/17
Signature -of Owner/. Lessee/Contractor as Agent for Owner
Signature of•Conteactor/License Holder__
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF c
COUNTY OF.
Theo oing instr ent was acknowledg before me
Cr
The forgoing instrument was acknowledged before me
this day of 20Q by
this day of 20_ by
31\3�A \ U0
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
Produced
Produced
(Signature.of Nq 1 ,, u ic-
(Signature of Notary Public- State of Florida )
GELA M HUFF
$� Notary Public - Stam nda
Commission I� _ •_
1 '
Commission No.
Sion # F�
4 234730
i�FOF �O` My Comm. Expires May 27, 2015
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REVIEWS
FRONT
ZONING
wIJ ERVISOR
PLANS
VEGETATION
SEA TURTLE
.MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW,
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Planning & Development Services' Department
COUNTY Building.&.Code Regulations
s R I D A 2300 Virginia Avenue �I
Fort Pierce, Florida 34982'
(772)462-1553 I
'I
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 ('n 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 liy� 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 licable
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 to eet
the minimum code. I� 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.
°s
Initial
I understand that if I compensate any person or company for work p ed they are required 0 be
licensed inthis jurisdiction. If for some reason they do not possess a license, I may be'responsible and liable f the
cost of the license. ! Initial
I understand that if any person that is unlicensed and uninsured gets injured ;on my construction p ,oject-
they may be entitled to workmen's compensation. I could be held liable for all doctor; lilawyer and related ical
cost, which could include loss of wages during recovery from their injury. i Initial
To qualify, for this exemption under this subsection, an owner must, personally I ppear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosures atement. and that I further
understand that any violation of the terms of the owner/builder exemption shall be rep rted by the Building .and
1nmgZ Departure th Florida S e Department of Professional Regulation. Signed ' d acknowledged on this
day of of 20 j
j
OwnerBuilder' Si gnatur
STATE OF FLORIDA
COUNTY OF
The egoing ins a as ackn w edged before, me this ay of II 20��
by P who is personally known toi me, or who has
inv
duced as identification..
Signature of o T e or Print ame of No 7 ""1)s N ELA M HUFF
o�P v p"% Nota1e State of�Fionda
Title: Notary ublic Commission umber=; mp Commission # FF 234730
- My Comm. Expires May 27, 2019
SLCPDSD Revised 05/15/2014°F F:°`' Bonded through National Notary Assn.
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BOARD OF
COUNTY
' 1 9•
EM4
Wkikid
Building & Code
dulation Division
Residential Fence Affidavit of Compliance
intending to be legally bound,
by
herecertify that work authorized by Permit Number 1710-0180 is Installed in
accordance with the approved drawing/plot plan/survey on file with the County.
I certify the fence is:
1. Located within my property boundaries.
2. Not located within any preserve areas or easements.
3. A Maximum of 4 feet in height in any required front yard SE
4. A Maximum of 6 feet in height on the side and/or rear of th
5. Not located within 50 feet of North Fork, Five Mile or Ten A
property was platted before 8/1/89 r not located within 75
was platted after 8/1/89.
6. Outside clear sight triangle (fence sh I be erected in such a w,,
sight distanck at any vehicular or pedestri access is maintained)
7. "Not used s a fence pool barrier (initial)
Owner/Contractor Signat re Date
t %
Print Name Cert. N
The foRgoing instrument was acknowledged before me this_t&day of
Notary P
Personally Known,
Type of ID Produc(
pack.
property.
e Riverine, if my
:et if my property
so that adequate
V ?
4
ANGELA M HUFF
Notary Public State of Flondq
i
_ a , Commission # FF 23470
S Yed§ �Q�1 . RRIERS MUST BE INSPECTED BY THE COUNTY
Bonded thr)!SU
ugh National latafy �QR,
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