HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application OCT 1 4 2017
Planning and Development Services PEMMITTING
Building and Code Regulation Division
St. Lucie Loi+ntv.
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATIQN N ;; 0141
Address: 40'S
Legal Description: C9. CL t o e DA Le— 5 T T
Property Tax ID#: D Z -7 00n / Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DS CRIPTION tJF WORK.•.•
a ✓L e --- e-li- ,4
e � a
CONSTRUCTIONANIF0,11MATI N':" ,`-'
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2 1115-Y Utilities: _Sewer _Septic Building Height:
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OWNERjLESSEE:
e CONTRACTOR
Name Q q, e S -�,C�G" Name
;N4,AP
Address: �O /� O Company:
City: C-! �`��l C L- State V L 'Address:
Zip Code: �= Fax: City,:.,. State:
Phone No. 7Z2';2�U -3-73-3 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.
SUPPLEMENT,L'CQN RUCTION I:IEN 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'0 er•/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAp � STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgoing instru nt w s acknowledged before me The forgoing instrument was acknowledged before me
this day of 20-l )by this day of 20_ by
Name of.person makiny statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati n Type of Identification
Pro ced 1.i Produced
oil
Sign ture of Notary Public- ate of Florida) (Signature of Notary Public-State of Florida)
Commission No. a R 11 `( e� AHNA N A Commission No. (Seal)
IGIIIM
;`6: Notary Public-state I Florida
Prq� s to I;�F 177 49
REVIEWS FRO T''%';, d��u h hf�r QJ fin. PLANS VEGETATION SEA TURTLE MANGROVE
COU , REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
�.._.
Planning&Development Services Department
(COD Building&Code Regulations
a-: 0 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 ap 'c le
laws,ordinances,building codes,and zoning regulations. InitialT
'4=
I understand that the building official and inspectors are not there to design or give advice on howa
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the minimum code. 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. n
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 liable th
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 relateed'ca
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
Z,.�on,in/g Department o the Florida State Department of Professional Regulation. Signed and acknowledged on this
lK day of 0t� of 20 h
/ Ux�,
CmlherlBdilder Si ature
STATE OF FLO A
COUNTY OF ^^^^
The fore ng instrument as acknowledged before me thc- Ply day of ON ,20I,
by who is personally known tome,or who has
e �Z as identification.
jrSig ature of Notary Type or Print Name o Notary (Seal)
Title:Notary Public Commission Number
� Ry P••• LASHAHNA IN(1RAM
SLCPDSD Revised 05/15/2014 '"'08
0 awn
«o' Notary Public-State of Florida
•c My Comm.Expires Dec 20,2018
'+ °e` COMMission 4 FF 177249
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Bonded through National Notary Assn.
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