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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: PQ3 ' Q3 -P z_ 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: PROPOSED IMPR01lEMENT LO ATIONy Address: O ' o,7 e;u Property Tax ID#: 13 `a Sl��- CK-014-0003 Lot No. Site Plan Name: 0 O � �/ f�%%�f 4 7-4 Block No. Project Name: �E AILED DE-�SCRF TION QF W©R�K. CONSTRUCTIONI INFORMATION: I 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:$ rj (► 6 fl. ff Ct� Utilities: —Sewer _Septic Building Height: 0AT,NER W&S—SEE: CONTRA TOR: Name Name: (-4 <A7 i 8 r AI Cr Address: lG'd o -3 1V PiR Company: : City: State: Address: Po T4 20. Zi Code: G Fax: City'Y State:',l. Phone No. 7 )�� ` / ���/`j Zip Code: Fax: E-Mail: Phone No I'V Fill in fee simple Title Holder on next page(if different E-Mail from the.Owner listed above) State or County License -Po At 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. SUPPLM'ENTA CO�NST +UCTIQN LIEN LAW INOR TION: 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." J��,� Signature f wner/Lessee/Contr for as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 11n ,dayy`of 20�40y this day of 20_ by Name of p son making statementQ Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signatu a of Nota ta psd ,� pj MING (Signature of Notary Public-State of Florida F ) *: My cQMMISSION#GG 275060 Commission No. �`.; EXPIRES: Commission No. (Seal) � F Bond er20,2022 ed Thru Notary Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 2/7/19 I - Planning&Development Services Department Building&Code Regulations 2300 Virginia Avenue j 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. 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 e: y 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. Initialg-Q S 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�2 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 401; 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 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��!' of 20#b i Owne Builder Signature i STATE OF FLORIDA ' COUNTY OF yy Th egoing ins eft was acknowledged before me this I�Q day of 2(0 , by , who is personally known to me,or who has duced as identification. �1Jr�➢�I�Q. i tury ype or Print Name of-Mkary v (Sea be of Nota Title:Notary Public Commission Number v�%? LASH SLCPDSD Revised 02/7C20 AHNA INGRAM-RAHMINGCOMMISSION#GG 275060 Po: EXPIRES:December 20,2022 i �A• .y'eoFS.•' Bonded Thru Notary Public Underwriters i I I ., Al LOT 163,HOLIDAY PINES SUBDMSION PHASE 1,ACCORDING TO I I THE PLATTHEREOF,AS RECORDED IN PLAT BOOK 18,PAGE 16, _ I 16A THROUGH 16D,PUBLIC RECORDS OF SAINT LUCIE COUNTY, - C�'1 y FLORIDA. •; �P LNG _ ADDRESS: 6003 NETTLE PATH DRIVE,FORT PIERCE,FL:MS1 o S•V` l[� SURVEYNOTES: `� �• •\'t ly i. SURVEYoPDEBCNtP11oNAs FGRNm=By GL1ENr-,Lmm BHowNW7tEONWERE ND NOTABSTRACIED FOR EASEMENDiMNIOR RIGHT OF-WAYS OF RECORD. Z TTSS SURVEY DOES NOTMANEANYATTIEMPTTO DELNEATE ORDEFIE ARM OF •. w�� .� 'O T� ' ENVIRONNIMALCONCERN O7HERTHAN PROVIDED AND SHOWN HEREON,THERE MAYBEAREASOPeffiROA WALCONCERNONTHBWMNOTNOTEDORMAPPED., 4 3. UNLESS N o ORY. w 0 Ba OTHERWISE STATED THE BASIS of eEAfmIOBAtA DISTANCES Anew Q ACCORDANCE WRNTRERECORD PATAND HAVESEEN VERIFIED BY FIELD p�('ou Zb.0 �4,. .�,e, fA�•' 4. ALL.MEASUREMENTS SHOWN HEREONARE IN FEET.' 6. ALL ELEVATIONS SHOWN HEREON ARE 800 ON , THE NORTH AMER"vmncU.DATUM OF 1888(NAVDM & THIS RmD MEETS OOS AACICEETFOREMEMB�Is PREPAACCOROWTOINESTANDARDS OF PR S FLORMAADMINISIWITNE CHAPTER ST•1lAB CORP.ADOPTED BYTHE BOARD OF FX WTI PROFESSIOUILBURVEYORANDMAPPEPB. a• 4�. G 1. WRITTENOIMENIONeTAIIe PR�EOENTOVEItBCALED 00.1E11810NBAND e'f}ISOLB . •0 -��- _ OF FEATURES ARE NOT TO SCALE ANDARE OD•YA REPRESENTATION OF LOCATION yN W 1�l1i19�UGEI(� IN THE FIELD, . i / A •j;C• 6003 •rO 8. THIS SURVEY 18 NOT VALID YfiHOUTIHE DRIOwAL SIGNATURE ANDFMS8161), . �. D p y� Lev, K{SI"1AIN SEALOFTE SURVEYOR IN RESPONSIBLE CHARGE TWO SURVEY CANNOTBS r/ TRANSFERREOORASSIGNEDWITHOUT THE SPECIHCWRITTENPERMISSIONOFTHE /Yy 9e � SURVEYOR HEREON,AND IT IS AVIOLATON OF CHAPTER SL17,FLORIDA 30 O ADMINISTRATIVE GOOETOALTER THIS 6URVEYWTrHOUTTHE EXPRESS PRIOR.. c, wRIRPN CONSENr OPTHE SURVEYOR ADOTIONS APMMUEIETOKB MADBTO THIS�gL SURVEY INANY FORM RENDERS THIS SURVEY INVALD.� .I. NO UNDERGROUND IMPROVEMENTS HAVE BEEN LOCATED AS PARTOF THE SURVEY. 10. BYACCU" nOBURVEY,ALLPARTIEBAOREETATTIESIGNMSURVEYORe TOTHEAMOUI(TPAID FOR EIM SURVEY. 11. OWNERSHIMPOFFENCE LIES HAS BEEN DETERMINEDAS PART OFTHIS SURVEY. �� A - t'y!_sGu(� !�G{G'L:}•1 11 12. TWa811RYE%!IC0A@LE WHENAULSHEETB LATHE MARE NDTSHoWNIN '( T l��• ^G7y QaLLOPB¢S N THE LAS T ISTI. 18. THE LA67FDI.D OATS OF THIS 6URVEYWAB' 1'+&r . FLOODZCNEIWORMATOW 96 FI EI'I' FLOOD ZONE: W,MAP: 12111000703 I �` �LNiO`LFi fENGB DATED:02/11/12 I63 V ICb�FCNrk .' 162' CERTIFIEDTO:. A"La y69'D toyl NSW F6UGG.?6�r16¢__ pp����1 .sA� LEGEND t 'YMOIEMOM OI -COR01[16 WWI<OR CN - A= CORNERSTONE SURVEYING 90UNDARY.SU kviy • -D wives` a .p��r°�®axumo n r m"m0O LB8 7041 o- QQIrO RA110 run Lao -NIT M�littmlt p f0ul MVARD a n[®I dl V . ' " ,T , A•l• 1/�n ICE .�r ar avwu w -r CLYOE_R.SABRING ,I IAAn•,c-j t! lLl�w- l A .Nu0M w mr .wml 1°a' -1A"D 328 8W SOUTH QUICK CIRCLE -rommOn ilrom r m mw 0 ' •-mum1r. w -�Crm1 . PORT ST.LUCIE,FLORIDA 34953 c DEW byk . MARK W.TEEPEE n or rmmcY -ruT®CommHrAllL r IOiRxa w I ,2378 PROFESSIONAL LAND SURVEYOR '° �01Oa"A"'� GADIIR riAIr,O v 1A1R'�! TEL UR"N GHOT ptp v mazes Wnrinaa! .o®m aRANQ r IId1Yo n> COIUNERItTTONEaupVEYINO®IIDTNAaCOM FLORIDA REGISTRATION NUMBER T14B11 a � anwoi Aro was y :��L i I I I I i I i I I I I ' I