HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: / Permit Number:
Building Permit Appli
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: 1 K,ro �bJn 4
Address: L G
Property Tax ID #:
Site Plan Name:
Project Name:
CONSTRUCTION, IN F0RMATl0 N:;
Commercial
L d I
ion JUL 9 2019
Permitting Department
si&"cie ebunty/ FL
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ GasTank _ Gas Piping _ Shutters _ Windows/Doors
Electric ✓Plumbing _Sprinklers Generator _ Roof 'Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ � U 0 Utilities: —Sewer —Septic Building Height:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
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
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 a plicable
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 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 liable for he
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 coed' 1
cost, which could include loss of wages during recovery from their injury. Initial
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
ZoW' g DepartmqRt to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20 Jq. .
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Owner uilder Signature
STATE OF FLORIDA ,
COUNTY OF
The foregoing instrument was acknowl dged before me this � day of
by o is personally kno to me, or who has
produce as i tification.
Signature of Not Yyje_y Print Name of Notary (Seal)
Title: Notary Publi Commission Number
SLCPDSD Revised 06/13/2014
AUOREY B. HUMPHREY
MY COMMISSION # GG 300617
�;•:oe; EXPIRES: March 6, 2023
Bpi Thru Notary Public Undewriters
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ST LUCIE COUNTY UTILITIES P. O. BOX,728 FT ;PIERCE; FL 34982 h
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SEWER : RES
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SUBDMSION �� LOT
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CFC/WATER
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PHONE MOVE IN/CLOSING DATE -----------------------
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CFC/SEWER
GUAR•REV
This apphcahnohereby request and;author�zes the Utilityto render water and/or sewage disposal
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se_cvices to the premises desenbed'above ui accordance with,the Uhhhe resent or utur.e rates,
LATERAL,
rules and re lahons which b refe'rence. are made: a art of taus contractsA ltcant of rees'to a ;' Y P PP g P y,
the Utility promptly for such services in accordance with -the established rules and'regulahons"
„TOTAL
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CUSTOMERS DEPOSITS -ARE NON NEGOTIABLE OR TRANSFERABLE.. ..
CUSTOMER1
GNATURE
SOCIAL SEC/
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NAME OF- SPOUSE
SPOUSE'SOCIAL SEC
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DATE RECEIVED ! CASH
O USE ONLY
OFFICE U ; �j //��,�I
RECEIVEDr:f I `