HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR'APPLICATION TO BE ACCEPTED
Date: .Permit Number:
Building Permit Application
Planning and, Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)"462-1578 -00171mercial Residential
PERMIT TYPE:
Address
IMF
Property Tax lD #: _ "7 j " a)---7 —S ► —C ODOC
Site Plan Name:
Project Name:
L
Lot No.5�
Block No. ��
Ct�1 � • ,p, A O
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:
Cost of Construction: $ ��%� Utilities: _Sewer _Septic Building Height:
Name=-1GS 9ff i1 ( r6 JOff
Address: �7 Qz�/
City: c/ 12 S ( jp C State:
Zip Code:(V Fax:
?hone No..%OS — 6 co
E-Mail: .3 .M (/Z d4 N!964,9 a:R=M , R/
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
.4 State:
�046:, ZIp �3 . Fax
:
E-Mail
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.
DESIGNER/ENGINEER? _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: A State:
Zip: Phone
Zip: Pon
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDIN OMP N : _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip:- Phone:
Zip: hone -
OWNER/ CONTRACTOR AFFIDAVIT: 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
with
which is in conflict any applicable'Home-Owner's 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 resttrrlctions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will,-in.all respects; perform,the work
in accordance with the approved plans, the Florida Building Codes and -St.; Lucie:County Amendments.
ency
The following building permit applications are exempt from undergoing a full concur.' 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
WIT OU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.t' .,
C
Si a e of Owner/ Lessee/Contra for as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFF
COUNTY OF
The fptgping ins ent was acknowledg� before me
The forgoing instrument was acknowledged before me
this day of 'VCR 20`�l by
this day of 20_ by
Name pers n making statement.
Name of person making statement.
\
Personally Known OR Produced Identification v
Personally Known -OR Produced Identification
Type of Identification '
Type of Identification
Produced
Produced
(Signature of Notary Public-S te.of Florida)
(Signature of`Notary�Public-State of Florida) '
v
Commission No.
Commission No. - (Seal)
vyirr"'•. IASWNAINGRAM•RAHMING
MY COMMISSION # GG 275m
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.`•
EXPIRES: Dace
ber 20, 2022
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REVIEW'
REVIEW
REVIEW
REVIEW,
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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 t a licensed
contractor who is not licensed to perform the work being done. Your construction must comply with1 able
laws, ordinances, building codes, and zoning regulations. Initia
I understand that the building official and inspectors are not there to design or give advic won o meet
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must AD 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�*/eqto be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible anthe
cost of the license.' Initi
I understand that- if any person that is unlicensed and uninsured gets injured on my construc *a
ject-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relatal
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 sigrKhe 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 gulatio Signed and acknowledged on this
clZb day of of 20 �.
STATE OF FLORIDA
COUNTY OF �s
The foregoing instrument was acknowledged before me this_ day of F , 20 L
by who is personally known to me, or who has
nrMilnPB 1_ 'i', nsk as identification.
Signature of Notary v Type or Print Name o Notary U (Seal)
Title: Notary Public Commission Number
SLCPDSD Revised 05/15/201 W 111A1 � 9Dd
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