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Home My WebLink AboutBuilding Permit Application I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 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: P4R PTOSED GNPR®MEi1 ENT L®CATIQNob Address: ,�LV rJ 5- Legal Legal Description: Property Tax ID#: �� o(.. Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DE AILED DESCRIPTiI.®.N Y� - C fltiti r CQ1S1"R`l1CTtC1' LNFOR{MATI®.N: b a Additional work to be pertormed under this permit–check all that appy: _Mechanical Gas Tank _Gas Piping _Shutters _Windows/D' oo' rs Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: . r Cost of Construction:$ Utilities: —Sewer —Septic Building Height: pWNE�RLE�SSEE; CON fRACT�OR: Name Name: Address: �,(U,`�r�c(�S v�-�� Company: City: l¢_c Cry, State:. Address: Zip Code: ILIQ Fax: City: State: Phone No. ��`� " `� �`�– �e�� Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail I` from the Owner listed above) State or Coun License If value of construction is 2500 or more,a RECORDED Notice of Commencem t is required. SUPPLEMENTAL C®NSTRUCTIIN LiiE'N LAW I�N:FORMATlON: 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 er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA / t STATE OF FLORIDA COUNTY OF COUNTY COUNTY OF The f1Qrgoing instrume tt cknowledge before me The forgoing instrument was acknowled d before me this day of 2011 by this day of _ by L.,C"Lr (Name of per cknowledging) (Name of person acknowledgi ) M (Signature of Nota Public-State of Florida) (Signature of Not/ryP- blic-State of FloridaPersonally Known OR Produced Identification Personally KnownOR Produced Identification Type of Iden 'fication Type QQf Identific ion Producedl� Produced Commission No. Seal . Commission o. (Seal) i ANGELA M HUFF REVIEVI% - ¢�30N�ommi Sion#FF 234730 �gmm.E?p17,2 1$'UPERVISOR PLAN VEGETATION SEA TURTLE MANGROVE i5 throig l IMaryAp REVIEW REVIE REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. Planning&Development Services Department COU Ty J! Building&Code Regulations • .2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 I 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 j 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, plicable laws,ordinances,building codes,and zoning regulations. Initia I understand that the building official and inspectors are not there to design or give advice on the minimum code. Initia_w o i I I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled j in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initi�rl� ; 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 li le r t 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 ed' cost,which could include loss of wages during recovery from their injury. Initial I To qualify for this exemption under this subsection,an owner must personally appear and-sign the building j permit application and initial the above. I 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 owneribuilder 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 !�7c��, of 20 . I � f �Oer�er�Signafti; STATE OF FLORIDA COUNTY OF Lc�el I The f regoing instrument was acknowledged before me the day of 20 1 by IC MA PTTAnn who is personally known to me,or who has i produced as identification. L'�F i Signature of ttary Type or Prr t ame of otary (Seal) Title:Notary Public Commission Number ANGELA M HUFF Notary Public-State of Florida j SLCPDSD Revised 05/15/2014 Commission# FF 234730 my Comm.Expires May 27,2019',, "OF, OFFLO�` g nded through National Notary A sn,fit_ A I II