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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 , Dater J 'l� Permit Number: I kq - ©� �I( E WED _ Building Permit Application SEP 0 5 2018 Planning and Development Services ST• L-icie Count Building and Code Regulation Division v Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 .� Phone,(772)462-1553 Fax: (772)462-1578 Commercial Residential ,p PERMIT APPLICATION FOR: , PROPOSES INPROVEMENT 'L �1 Address: -'7l 11 rct i?G� Fi- P1� Fl 1 '3 7�g 2 Legal Description: PropertyTax ID#: 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front . Back: Right Side: Left Side: DE AILED DE�5CRIP i0N OF WORK: 'A 06 CO ST.RtUCT O INFO ��MATION: 1A)JtY- nal work to be pertormed 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:$ i` /�00 Utilities: _Sewer _Septic Building Height: OWN'.�Rf LE-�S�SE CQ 1"RA� OR: Name 411 046c), Name': ���� `7-oi�-WA Company: Address: = City: State:,, Address: Zip Code: Fax: City: State: Phone No. !�f'- `7 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. NO, NORM CC}NSTR TON LIEN L�1W t 'FURMATIRN: 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 prohibitsuch 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 11('+I E COUNTY OF The fgrgoing instru ent w s acknowledge before me The forgoing instrument was acknowledged before me this r day of 2016 by this day of 20_ by I'm �So N Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Iden tion Type of Identification Produced L L✓ Produced (Signature of Notary5NT Ii (Signature of Notary Public-State of Florida) P�/� :=FPSEN Commission No. ��-,Sy Public Commission No Seal07484pires REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW. REVIEW REVIEW_ REVIEW DATE RECEIVED DATE COMPLETED ev. RECEIVED Nw Planning&Development Services Department COUNTYBuilding&Code Regulations s R I D A - 2300 Virginia Avenue 0 5 2018 Fort Pierce,Florida 34982 (772)462-1553 fi i;;,_f Cp ;nty, Permitting OWNERBUILDER 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 withc ble laws,ordinances,building codes,and zoning regulations. InitialM I understand that the building official and inspectors are not there to design or give advice on h eet 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 li f 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 rel at a ical 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 DepartZnt to he Florida St;tF Department of Professional Regulation. Signed and acknowledged on this day of of 20 1Z Owner uilder Signature STATE OF FLOR ` COUNTY OF Theregoin strument w acknowledged before me this day of ,20 j? , by who is personally known to me,or who has producedL as identification. l , �J Signature of Notary Type or Print N o Notary (Seal) Title:Notary Public er - KAR Y'"B:State of Florida-Notary Public SLCPDSD Revised 05/15/2014 - •2 Commission#GG 2074'64 / _* oPc My Commission Expires '' $ii. June 12, 2022 l y •r S L '� 574 S t� t - p y; , 1'C $T LUCIE COUNTY UTILITIES P O BOX 728 FT PIERCE FL 34982 - ` NAME r V St. Lucie County - PCIS 09-05-2018 01 :46:28 �►CCT�# x R l 18026/6535 P SE-k-1-p DDRESS s� j�jl;✓1 Qp�tQ OLSON, KIM 1 i 5714 TANGELO: , y{ FORT PIERCE FL 34982 Amount Tendered: 519.00 L` iBILLINGAbT)RSSJ11. I � G1L :D 3 4 y, r73, _._ Fh :' Amount Paid: 519.00 ! ;PHONE'# �t 1Y F rI N I Change Due: 0.00 MOPE IN/CLOSING DATE t Thank You This application`hereby request and authorizes the Utility to render waterand/or seLvj±age disposal services to the premises described above in accordance vinth the Utilities present or future rates, w rules aad regulations whit byareference are made`a paid of this contract Applicant agrees to pay3� t x the�Utility promptly for such services m accordance User ID: RODRIGUEZM with the established rules and regulations '. r} ,,� CUSTOIVIER,S DEPOSITS TARE I�.TON NEGOTIABLEeOR TRANSFERABLE l r G"` � L t f f. r SPOU$E SEC Q OFFICE'VSE ONLY DATE RECEIVED /I CASH tiCHIE# Y RECEIvEI)'�B RECEIVED SEP 05 2018 ST. Lucie County, Permitting