HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
_�►-� Permit Number: 5q
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RECFT\./F.-
Building Permit ApplicationJUN 14
Planning and Development Services ST. Lucie Count P
Building and Code Regulation Division y, er;
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
4'
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PERMIT APPLICATION FOR:�p�
Address: VOR IT -�
Legal Description:
Property Tax ID #: CD 1— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D OF WORK:
01
LID Z, 3 0 UVAMA
Additional work to be performed under this permit-check all that 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: $ &Z0(_). Utilities: —Sewer —Septic Building Height:
it
Name w ej&LQ Name:
Address: 900 L-a-kCompany:
City: State:L Address:
Zip Code: Fax: City: State:
Phone No. Il�R67��7o2tiL 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.
LAW INFORMATION: 77-7
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 thepermit 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 for oing instru ent was acknowledg before me The forgoing instrument was acknowledged before me
this T day of 20" by this day of 20_ by
L o y 1p'ex° Xy
(Name of person ac nowledgi g) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced oduced
KAREN S. NIELSEN
;state of Florida-Notary Pub is
Commission No. = 05eaf)ssion #GG 207413A mmission No. (Seal)
�A
ov My Commission Expires
r.
" June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
t
Planning&Development Services Departme at
COUNTY Building&Code Regulations RECEI FIF
..._..... .. L 0 R I D A .•2300'Virginia Avenue
—A Fort Pierce,Florida 34982 „
(772)462-1553 J U N 14 2 C,A
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT ST. Lucie County, Permitr!u
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. Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet
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.
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 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.
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 ownerlbuilder exemption shall be reported by the Building and
Zoning Departmen to t e Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20 .
Owner/Builder Signature
STATE OF FLOW
COUNTY OF
Th fore oin instru as owledged before me.this day of ,20�,
by r r who is personally known to me,or who has
produce as identification.
Si ature o o Type or Print Name of Notary (Seal)
Title:Notary Public Commission Number
SLCPDSD Revised 05/15/2014 � KAREN S. NI E LSE N
State of Florida-Notary Public
Commission fi GG 207484
My Commission Expires
Q ° June 12., 2022
Planning&Development Services ASBESTOS NOTICE TO OWNEWBUILDER
Building&Code Regulation Division
2300 Virginia Avenue
Fort Pierce,FL. 34982
Phone:(772)462-2172 Fax:(772)462-6443
RECEIVED
JUN 14 2018
June 14, 2018 ST, Lucie County, Permitting
LOVERNEY FOSTER
4902 LAKEWOOD PARK DR
FORT PIERCE, FL 34951
RE: Building Permit Number 1806-0359
Disclosure Statement: State law requires asbestos abatement 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 you own
asbestos abatement contractor even though you do no have a license. You must supervise the construction yourself.
You may move, remove, or dispose of asbestos containing materials on a residential building where you occupy the
building and the building is not for sale or lease or the building is a farm outbuilding on your property. If you sell or lease
such building within one year after the asbestos abatement is complete the law will presume that you intended to sell or
lease the property at the time the work was done which is a violation of this exemption. You may not hire an unlicensed
person as your contractor. Your work must be done according to all local state and federal laws and regulations which
apply to asbestos abatement projects. It is your responsibility to notify the Department of Environmental Protection of
your intention to remove asbestos. It is your responsibility to make sure that the people employed by you have licenses
required by state law and by county or municipal licensing ordinances.
Owner Signature & Date
6/14/2018 10:55:37 AM
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