HomeMy WebLinkAboutophellia_2020_04_20_10_35_48_370All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nui
COUNTY
F L O R 1 O A_ -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
9�:U�IIW\'1�7
Building Permit Application
Commercial Residential
C '�i s
PROPOSED IMPROVEMENT LOCATION:
Address: 1 i "? 6 e.Q c. % Ill yG g IA rG 7 pp
0,- f S4 Lu tk ci S 2
,
Property Tax ID p: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:.
eoc4 l c .�SOO.o0
CONSTRUCTION INFORMATION:
Additional work to he 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:
Address:
Cost of Construction:$
Utilities:
_Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name O
S
Name:
Address:
Company:
1
City: �or l S+ 4t. f.
Zip Code: 3 (I-9 S 2 Fax:
Phone No. _� i 7 L 21, 9
State:
1 12
Address:
City: State:_
Zip Code: Fax:
Phone No
E -Mail: - oyp
Fill in fee simple Title Holder on
from the Owner listed above)
I ext page (if different
E -Mail
State or County License
IT value or cgnnrurnon IS >eauu or more, a HtLUKULU Notice Or commencement IS required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
COUNTY OF
Address:
The forgoing instrument was acknowledged before me
City:
Zip: Phone
State:
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Produced
Address:
(Signature of Notary Public -State of Florida )
City:
Commission No. (Seal)
City:
Zip: Phone:
FRONT
Zip: Phone:
SUPERVISOR
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat 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 ermit holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anr�covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and reviewyour 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."
Rev. 21111',,
Signature of Owner/Lesse romtractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this /3 dayof. Opy .20,QQ by
this _day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification V
Personally Known_ OR Produced Identification
Type of Identification
Type of Identification
Produ ed 'Fjr DL
Produced
naCure of Notary Pu E IAB
wda Public Stale of Rarda
(Signature of Notary Public -State of Florida )
s'
Commission No. m tssianp GG 335182
MY !exgres May
Commission No. (Seal)
66 33s faa 15.2823
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 21111',,
t_v, LL (f
Planning & Development Services Department
C L• P C & Building & Code Regulations
2300 Virenta Avenue
Far[ Pierce, Florida 34982
(772)463-1553
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 most 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 be supervise people working on your building; it
is yew responsibility to make sure that people employed by you have licenses required by state law and by county
or municipal licensing ordinances.
Initial Here. vi -✓I
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 Here. Q PNJ
You may not delegate the responsibility for supervising work to a licensed convector 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 Here.0 WI
I understand that the building official and inspectors are not there to design or give advice on how to meet the
minimum code. Initial Here.0 /✓(
I understand Oiat as an owner -builder that any contract disputes with sub -contractors and I must be handled in a civil
court with the advice often attorney. This department will not mitigate any contract disputes. �-9�
Initial Here. 0I
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, 1 may be responsible and liable for the cost of the
license. Initial Here.Q
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 Fl
could include loss of wages timing recovery from their injury. Initial Here. \J
ryl
To qualify for this exemption under this subsection, an owner must personally appear, sign the 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
Departmcpt to Ore Florida Stale Department of Professional Regulation. Signed and acknowledged on this 1Z
day of fYOn/ of20 a�1_Q d�2�///J4
--iT""O— Owner/Builder Signape
STATE OF FLORIDA „
COUNTY OF 1,
The foreg . g o'ument was acknowledged before me this � day of �n , 20 � ,
by �D�jp/j0. ii7 U ��-/12 S who is personally known to me, or who has
produ d L (7 as identification.
C11 /5 ZJK'n ✓ ✓9-7"
Signa fN tory ype or Print Name of otary (Seal)
Title: No ary Public Commission Number 3 %_) d
IGUEZ ARIAS
RM
te of Fiend8G 335182 May 15.2023