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Home My WebLink AboutUpdated Permit Packet A►1 APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1505 -o Date: Permit Number:Suildil W..r..., m-Permit Application 1 Q Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 ,Phone: (772)462-1SS3 Fax:,(772)462-IS78 �Carmmercial Residential PERMIT TYPE: 6�7 PRnPnSFn IMPRn\/F1MFNT I OCATION Address: �� Wooc� OMs C��V� P3(A Property Tax ID#: Y1571 b 1 C)O 3000-q — _ _ Lot No. Site Plan Name: Block No. Project Name: UL I AILtU iJLbLKRJ I IUN Ut- VVUKK: ahT k S�&t ()�- R i�c,� D� ��w�. `(`6 h( rt �-5�: `j t, nch -h% (3,e- -b-- ��o� - K,(c ,trseh zDA ae IRI ch T S?_► sh 000 PSS w;k1, 5 1'.eQ3o r Li i r. k :rh i(.- ' CONSTRUC ION 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€loan. Cost of Construction:$ Hkcj. Utilities: —Sewer _Septic Building Height: �\NNER/LESSEE: _ CONTRACTOR: - Name lVl ChO.e _� �—_ Name: Address:-V) pjood 1atll , company: City:�)o Ck S-L, V L t _State: Address: Zip Code: yRSZ Fax: City: State: Phone No. (,,36 $5 Z -53.� Zip Code: Fax: E-Mail:��U� 63 � a hop, C a N'1 Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) ,tate or County License If value of construction is$3500 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. SUPPLEMENTAL CON,STRUCTtON UEN LAW WFORMATQN: I DESIGNER/ENGINEER: _ Not ApplicableMORTGAGE COMPANY: — Not Applicable Narne: ft6'0. 1� ,O-f ne Name: Address;_?q 1 %16" OX4 S b r'�Ve Address: Citylbl-�, S.k, Lyc: e- State:-4�-1 , 0ty: State: Zip: _ Phone bio esti-)..-93 VO Zip: Phone,- FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: -City: I 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 wilt authorize the permit holder to buird the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict of 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.wik6,in alt respects, perform the work in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. The following building permit app5kations are exempt from undergoiog a full,concurrency review:room adckions, accessory structures,swimming poois,fences,warts,signs,screen rooms and accessory uses to-another non-residential use OWARNING TO OWNEW. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A .NOTICE OF COMMENCEMENT MIDST BE RECORDED AND POSTS 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." Signature of Owner/L.essee/Contracto Agent for Owner Signature of Contractor/license bolder CTATF OF FI nRinA CTATF or Fi nRim COUNTY OF. J..(/L, COUNTY OF The for oing instrument was acknowledgeA before me The forgoing instrument was acknowledged before me this=-J-day of 20 by this day of 20— by Name of person making statement. Name of person making statement. Personally Known UK Produced Identification Personally known UK Produced identification Type of Identification , 1 Type of Identification Produced { Produced /I S» >Signature of Notary Pulyli ate of l:iorida l =9 G (Signature of Notary Public-State of Florida Commission No. (Seal) Cnmmiccinn Nn _ (Scall Ko gm < mm fDo 3 �–Di REVIEWS FRONT ZONING 11 PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW $ � REVIEW REVIEW REVIEW REVIEW DATE RECEIVED .DATE rn AlintErcn c. e0/. 7/19 aauaes PLANNING AIND-DEVELOPMENY SERVICES DEPARTMENT N`£ BUB-DING AND•CODE REGULATIONS DIVISION ' 2309 VIRE MIA AVE FORT PIERCF,FL 349U (772)462-1353 Fax(772)462-1579 PERMT RENEWAL REQUEST PERMIT 1vUl : ��5�5-� �-� S A ss: 5�9� ti✓oad lana(s�r. o�� S�l..�� 3y95z t, AM(.&( e T \2 r r _ am:requesting that the above mit be renewed I understand that'l must schedule and pass all required inspections for the permit to be finaled. Further, I understand that.this is a ONE TME RENEWAL and the permit shall expire should I not receive a passing inspection during any six nionth period daring the renewal period. Justification 2-0n t� C. O E 6LDR OR CONTRACTOR SIGNATURE DA E _Lh ha T. (IDn o r nL? Print Name STATE OF F�_O t,IDA i•VL 1 Y.11 1J.I 1(.��T-T� ACKNOWLEDGED BEFORE ME THIS_�.�DAY OF 20 4) BY WHO IS PERSONALLY KNOWN TO ME ,OR HAS PROVIDED �, L . AS IDENTIFICATION. STATE OF FLORIDA,County of. S1 NATURE OF N'OTA&RYSEAL,40&*Z -- -- - ---��-----__---__--------------- n - ——————-———-—- FOR.OFFtCE USE ONLY-.. Ko m= c3 mm CD03o > a o -• —I Number of Open Inspections: a 3.y T z m3o � Total inspections; m a y m (Divide upea by total to get%of open wspections) d W Percentage.: Nm'o mm c � Original permit fee: x%open = $ Renewal fee N" a'< w Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee) " C7 Revised 7/2)1/2014 .f' v Planning&Development Services Department p t r Baailding&Code Regulations 2300 Viuginia Avenue Fort Pieree,Florida 34482 ixaa>462-1553 OWNER/SUII.ItER AFFMAVIT DISCLOSURE STATEMENT _F.S.4".1eY(').EXE 11dPT10NS State law requires construction to be done by aicensed 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 duct,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 occopancy.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 couiity or municipal licensing ordinances. initial Here. m,"T If you seB or lease a building you have btift or improved within one year after construction is complete, toren a presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. Initial Here You-may not delegate the-responsibility tor-supervising w4xk-to a-licensed contractor who is not licensed to perform ♦4.. L be fi ._ .L_.... V...... �:,.« . 1.. .'.L it 1:....1.�.. 1..._... A:--«--- 1...:1.7:..._ ,7.... A u.� wvrn u�ua, uum'. a uul CviLiwuCuvu MLLOL %,VIII7cy wiuc au aYYuuau.� lawn, Orulucuiuw, uw.uuls wuw, aitu zoning regulations. le ial Here. m-T. I understain that the budding offieW and inspectors are not there to design or give advice on how to meet the minimum code. llnitbd Here. M I• 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. Tins departmeat will"mitigate any contract disputes. Initial Here. 0).T. 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 Here. M7T• 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. T cm 'be held liable for all doctor,lawyer and related medical'coax, which could include loss of wages during recovery from dreir injury. Initial-Here To qualify for this exemption under this subsection, an owner must persona>tly 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 wohmm of the terias of dae owner/builder exemption slaabY be reponed by the Building and Zoning Department to the Florida State Department of Professional Regulation. Signed,and admowledged ori this --- day of of 20_ Owner/Mlder Signature STATE.OF FLORIDA �- COUNTY OF The foregoing instrument was acknowledged before me this day of 20� , by who is personally known to me,or who has m m produced as identification. o�.o y /�rh3! f�JtCitt� !CX/Y�..1�r1K1� o m Signature of NotaryType or Print Name of Notary (Seal) rn o z 0° Title:Notary Public Commission Number Na au< ( w�0 m -NG rrJ v a l7 0' PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING II111VRSI0N 2304 VIRGINIA AVE FORT PIERCE,FL 3498.2 (772)462-ISS FAX 462-1578 CHANGE OF CONTRACTOR -SUB+CONTRAICTi�R-0R CANCELLATION-( F WRMT PLEASt SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR-Chmge ofCosltractor is to be signed and.notarized by the property owner, and the new contractor of record for the current permit.A new permit application must also be completed with new ,00ntractor information and signature. A am.Notice-of Comnumcement must tie filed in the new contractor's name _for .job values greater:than -$2,500 ('$7,500 _cif.AiC rqe-out). -A .mcor&d copy -must'he .submitted .prior_to Ti cc -en i n on�r �t.nr4 There is n eC(1 M{fed fnr tho ChangenF/''nnMwctnr. CHANGE OF SUBCONTRACTOR-Subcontractor changes are to be completed by the general.contractor. T new subcontractor must fill out a Subcontractor Agreement Form. There is a$50.00 fee for the Change of Sub- Contractor. CANCELLATION OF PERMIT-The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is.-to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: -t�I , 120 -)_0 Permit \lumber: 1.50,`7x-O 219 Site Address: A 9� 1 o( _LL1 Y\( -�C � S t a'f GAJ / 2-- J a�d 0"n0 Ste state license SLC facense Original GC,-subcontractor or ownerlbuilder 1 M&t C.hd2.\ ` 6:0 f jsP ( JAQ 2 O w"- State License`----- L'---SC License New GC,subcontractor Reason for Canceration �O00 10 hQ f Y L X 1/)SCj The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all costs,fees or damages arising from any and all claims of action for any reason;which may arise as a result of this change of contractor/subcontractor or cancellation of permit.A permit vmwat be rancelied if work hvs been performed. SIGNATURE OF—OWNER or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME j \t \QQ j �h at a JLTNTNAME .d,5.,ro State of Florida,County of St.Lucie County ''= tate of Florida,County of St.Lucie County a= The.following.instrument was acknowledged before me this "` y,r..' a following krAnamett was acknowledged before me this 3daof ,,,. y ��r� ..��y vt ---day of 2U ,by— �om2 who is personally known to K 3 (D M who is personally known to or w has roduced asID. 6 0 3_ A—t p �, or who has produced as ID. � 3a, :'2 � 3o-Om Signature of Notary Date rn T.s Z to Signature of Notary Date oC 0M gm x T N� � K Revised 04/15/16 n =;. N c x