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Home My WebLink AboutBuilding Permit Application 0 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q �1 Date: PIrmit Number: I D� 1• a� I Building Perm! Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 PI one: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: I1rf}R ��u✓�I �, I ,F/,��,L "9- ED, PAOVtW 9-ED,INPR:OVEIV N tbtAfIQN Address: dl>lo ,t R R _ o _ �Jr•� Com- l�.L g �r2 S Legal Description: oa lD Property Tax ID#: Lot No.� Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side:I Left Side: DED OFSCRIPTION QF WQRK• D6 )9 vVA S ONSTRUCTION,IN�FORIUTATION —5na work to l5e peffio-rmed under this permit-check k a that a' ply: _Mechanical _Gas Tank —Gas Piping Shutters ' Windows/Doors _Electric _Plumbing _Sprinklers TGenerator _Roof Pitch Total Sq. Ft of Construction: fib Sq. Ft.of First Floor: Cost of Construction:$ b D coo ST Utilities: —Seer _Septic Building Height: av �lR/LfssEo coNT ACTOR ;Name NIP Name: Address: 4666 IBJ /�,c f},y� �� Compa y: City: FT- P r r R C-F State: Address Zip Code: Fax: City.: A.. State: Phone No. Zip Code: Fax: E-Mail: viiLL i�mr.�SS�d�� %/ ,�Z�/ Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner.listed above) State o County License If value of construction is 2500 or more,a RECORDED Notice of Commenc1ment is required. SU.PPL ,MENTAI.CQNSTRUCTIQN LIEN LAW INFORMATION s 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. Va'lt� 1 Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFCOUNTY OF The forgoing instrument was acknowledgebefore me The forgoing instrument was acknowledged before me this'10 day of 201 by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) ( aturk 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 -'— Produced , LASHAHNAINGRAM \'=_ Notary'�S� I State of Florida Commission No. Seal Commission No. I �. - l _., My Comm.Expires Dec 20,2018 Commission#FF 177249 Bonded W1041I REVIEWS FRQv1v'-=-MIM' SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. .E ��Mr ns:. 'r�x�•Fh� • Planning&Develo meat Services Department • Building Code Regulations • • 2300 irginia Avenue Fort Pi rce,Florida 34982 ( 72)462-1553 OWNER/BUILDER AFFIDAVIT DISCLOS RE STATEMENT F.S.489.103(7)EXEMPTINS State law requires construction to be done by licensed contrac ors. You have applied for a permit under an exemption to that law. The exemption allows you,as the owner of you property,to act as your own contractor even though you do not have a license. You must provide direct,on-site s pervision 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 th purposes of selling or leasing that building. If you sell or lease a building you have built or improved within on-,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 sup'rvise people working on your building; it is , your responsibility to make sure that people employed by you have Ili eases required by state law and by county or municipal licensing ordinances. You may not delegate the respoitsibility 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 //_Jl I understand that the building official and inspectors are not ere to design or give advice on how to meet the minimum code. Initial 97711._1 I understand that as an owner-builder that any contract disput n with sub-contractors and I must be handled in a civil court with the advice of an attorney. This department will no mitigate any contract disputes. Initial 9')) , 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 I icense,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 li ble for all doctor,lawyer and related medical cost,which could include loss of wages during recovery from their injury. Initial_9>2 z/_ 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 I above disclosure statement and that I further understand that any violation of the terms of the owner/builder exe ption shall be reported by the Building and Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this 0 day of t.-4 of 20 OwnerlBuilddr Signature STATE OF FLORIDA COUNTY OF 5 �� A✓ The foregoing instrument was acknowledged before me this. do of ,201 , by who is personally known to me,or who has oduced as identification. �T_ c ig afore of Notary Type or Print Name of o j Title:Notar�Public Commission Number •,,,,,,,, LASHAHNA INGRAM SaosnaY n��% Notary Public State of Florida ` .# *• My Comm.Expires Dec 20,2018 SLCPDSD Revised 05/15/2014 Commission it 1+177249 Bonded through National Notary Assn.