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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:- Permit Number:.190 0, 12P RECEIVED Building Permit Applicati-i n 0 19 Al� 'A� 0 8 2019 Planning and Development Services Building and Code Regulation Division ST. LUcie-County, Permitting 2300 Virginia Avenue,Fort-Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial -Residential PERMIT APPLICATION FOR KI a.A t_� I,- p -7C) V Ir Address: Legal Description: ID#: o Lot No. Pro perty Tax Site Plan Nari Block No. Project Name: Setbacks Front Back: Right Side: Left Side: C Le t�ffl ���100W�WRX.�__, yli 4_( C_ MW N Additional work-to be pertormed under this permit-check all that apply: —Mechanical —Gas Tank —Gas Piping —Shutters Windo' ws/Doors Electric —Plumbing Sprinklers Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: IJ AJ A T�-t ,,,,Name: Name P 9Mpany!..-1 Address: 59 11 ' ) - 'Add res�;� City: 'Fc>P.�r (r= ol State. Zip Code:-3ff J 8 Fax: city. State:, Phone No. 7 7,9-- q-7-q Zip Code: Fax: E-M a i 1: do Y\no-Z C(DW Phone No Fill in fee 'simple Title Holde r on next page I 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. 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. .tlignature of Owner/ sse ont actor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF .S rrr. 1-.V c%F_ COUNTY OF The going instr ment was acknowledge efore me The forgoing instrument was acknowledged before me this day of 20by this day of20_ by old. 0 Name of person making statem nt. Name of person making statement. Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Identific Type of Identification Produced Produced La A c1 1_ ( ignature of Nota Pu c-Si to of F orida _ - (Signature of Notary Public-State of Florida) ;.��a��P�%,� �1 REN S. NIELS Commission No. ° �: of Florida-Notary, � o mission No. (Seal) -i `= Commission#GG 207 84 1 �° M Comm' "'" June 12, 2022 REVIEWS FRONT Z NS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW 'REVIEW .. REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED- ' Te-VT. Planning&Development Services Department fColiBuilding&Code Regulations RECEIVED i 2300 Virginia Avenue Fort Pierce,Florida 3498E (772)462-1553 JA 0 $ Z 019 OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT Sl". Lucie County, Permitting 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 ofyour 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 tease 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 AW 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 Iiable 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 owner/builder 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 r) A/Q UA-&-Vof 20 1 �� OwnerBu�Si STATE OF FLO A COUNTY OF Q� foregoing instrument was ackno ledged beforeme this_6 day of --..20.ri ' by who is personally known to me,or who has produced l� as identification. Signature of Notary �_i (Seal) Title:Notary Public ,!;p��, CodUhf Yh Ru1W6W S E N �o State of Florida-Nota * *t Commission#GG 207484 SLCPDSDRevised 05/15!2014 ;?, B�YPP`: My Commission Expires 'nnu,� June 12, 2022 �.. M, .:,..._, �.�_. .. ..... . . I Eljpti E" r s ry 1h s �f a .ir Y � sz ✓. . { ST LUCIE COUNTY UTILITIES P O BOX-728 FT:'PIERCE"FL 34982 _F t NAME Ar'!I/ .L7 it. Lucie County - PCIS H H-08-2019 02:11 :14 � r � - 18406/4373 EP � SERVICE ADDRESS �^ �, © n Ya 'ATYKO, DONNA J. I' t i911 HICKORY DR v 'ORT PIERCE wj SUBDIVISION fv%ODNf FILE 'L 34982 IEE 3 � ,{ LOT BLOCK FEE , r 4 c / Wount Tendered: 520.00BILLINGADDRESS amount Paid: 519.00 '.• io' 4 E �- `: PHONE#' r ,hanse Due: 1 .00 a MOVE CLOSING DATE t Y. � Tfi�s application hereby request and authorizes the Utility to,render water and/or sewage disposal thank You services to the'prenuses described;above in accordance with the Utilities present or,future rates rules and regulations,whi h by reference ace made a art of this contract.A` hcant a P pp grees to pay the UUhtypromptly for such services`m accordance with the established rules and°regulations Jser ID: RODRIGUEZM CUSTOMERSDEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE E l` `SOCIAL SEC � ' SPOU$E SOCIAL SEC - ,u,-.., ,,r , � �r OF E USE ONLY _ _ DATE RECEIVED CASH CHK# . RECEIVED B: =RECEED