HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE
USTBE COMPLETED FOR APPLICATION TO BE ACCEPTED 9
Date: /�/ (� '/ Permit Number: /107 D3L-7
RECEDVED
Building Permit Application g
Planning and Development Services JUL 1 2019,
Building and Code Regulation Division Permitting De��rtment
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial 11esftnjilI (tbl in y, FL
PERMIT TYPE: C �/Y�
a
PROPOSED IMPROVEMENT LOCATION: r
Address: ,f� ` -
�� 68 2, (r e 16,25 0 0A y
, �'t , 1;[',��� ^� �, 34 1
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Property Tax ID#: —,7M - � 2 - Q� ` � � L9 ° Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE=SCRIPTION OF WORK:
I a ce- 6 t
;5
CONSTRUCTCON INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE. CONTRACTOR:
Name Name:
Address: ?-1;3 k;'s 5 R"5 0: Company:
City: �- 1 ���e State:� Address:
Zip Code: �J�}cl y Fax: City: - State:
Phone No. - 7 7 Z ��_�' S S4 /o Zip Code: Fax:_
E-Mail: b f -POI V, gto�_,C��`� 16,6k, QDm 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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLE",MENTAL CONSTR CTI(EL1'EN LAW INFOR+MATION:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Thef r oing ins n was acknowledge efore me The forgoing instrument was acknowledged before me
this day of 20// by this day of 20_ by
-�V )
Name of persorVnaking statement. Name of person making statement.
Pers0nall�lf7ro n OR Produced Identification Personally Known OR Produced Identification
Type of Identific i nn r Type of Identification
Produced Y ' Produced
(Signature ofo aryu lic-State of Florida (Signature of Notary Public-State of Florida)
Commission No. :i:nY On Commission No. (Seal)
:* Y COMMISSION HREY j
M #GG 300
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pD_ ,2OZn 2 4
•'•POFF��:�••,Wn 3 '
REVIEWS Q2211kU OR PLANS VEGETATION, -SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
iST. LUCAE Planning&Development Services Department
'COUr--4TY Building&Code Regulations
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
OWNERIBUILDER 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 ap lic ble
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 et
the minimum code. Initial
V
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 or 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 me ical
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 owneribuilder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed'and acknowledged on this
AG_day of of 20 P .
O)Me-r/Builder Signature
STATE OF FLORIDA—
COUNTY OF
The foregoing ihstrum nt was ac le ed before me this day of 20
by io A - who i I s personally known tf)ne,or who has
produpQd f-. rk,�_ i as ide fication.
Si re of T e or Print Name_ofNJ6ry (Seal)
Title:Notary Pub c Commission Number
SLCPDSD Revised 06/1312014
HUMPHREY
My COMMISSION 9 GG 300817
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...... 4"; E)(PIRES:March 6,2023
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