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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �+ Date: Permit Number&oos, _I� : r 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 Commercial Residential PERMIT TYPE: PROP© LSD FMP OVEMENT LO TIO Address: �I Ll OL VAA i � e Property Tax ID#: i IAI��A 04`44 Lot No. Site Plan Name: Block No. Project Name: DE A)LD ©EMPTION own e c e r CONSTRUCTION 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: Cost of Construction:$ XV , � Q Q n Utilities: —Sewer —Septic Building Height: O�WiNER/LUSEE: CONTRACTOR: NameTz� yCj - Q - C o D Name: Address: 58 uu Company: City: c P `12 <' e State:� Address: Zip Code:' 3 / 10 Fax: City: State: Phone No. - O 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. 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: State: Zip: Phone" Zip: Phone: FEE SIMPLE TITLEHOLDER: 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 91WARNING 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." �ign#iture of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF1�,�,�_ COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of � , 20-)-Z)by this day of 20_ by t v�) A n"AJ Name of person making statement. Name of person making statement. Personally Known OR Produced Identification n Personally Known OR Produced Identification Type of Idi on 'Type of Identification Produced «= Produced ign ture of Notary Public- tate of Florida) (Signature of Notary Public-State of.Florida) El. �HN�IfRAM-RAHMING Commission No. (Seal) Commission No. OMMISSION#GG 275060IRES Dece Thru Notary,P iblic Underwriters REVIEWS FRONT PLANS VEGETATION SEA TURTLE. MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 2/7/19 s _J Planning&Development Services Department COUPITY Building&Code Regulations 2300 Virginia Avenue Forf 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. 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. Initial 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. Initial 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 o s n 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. Initials 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 medical cost,which could include loss of wages during recovery from their injury. Initial� -T I 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 Zonng Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20 20 . O erBuilder Signature STATE OF FLO COUNTY OF � � �., � oing instrument was acknowledged before me this Lu day of + '�-n?K ,20%),(-) , by who is personally known tome,or who has roduced as identification.- ature of Notary Type or Print Nam f Notary (Seal) Title:Notary Public Commission Number SLCPDSD Revised 02n120 t• '"�"�` LASHAHNAINGRAM-RAHMING lMY COMMISSION#GG 275060 -W-- EXPIRES:December 20,2022 •.�,F F�.• Bonded Thru Notary Public Underwriters i Fort Pierce Utilities 206 S 6th Street Fort Pierce, FL 34950 Telephone No. (772) 466-1600 02/28/20 3:25PM Receipt #: 005200228000011 Customer #: 153516 Location #: 10008079 ' For: JOSE A SORTO Payment Received: 290.00 Amount Tendered - Credit Card: 290.00 Authorization Number 028363 j Payment will be posted: 02-28-2020 Register: CASHIER5 Thank you - Have a nice day... . NEW HOURS M-F 9AM - 5PM DRIVE THRU SAM - 5PM www.FPUA.com * Budget Billing Now Available * CUSTOMER COPY