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Home My WebLink About Building Permit Application All APPLICABLE.INF4?MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (0 g-o-,-aPermit Number: 2 O O — U.-0 Z Building Permit Application Planning and DevelopmentServices Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 PERMIT APPLICATION FOR: . ::.ti .. .r=3. w�.«s.e: .� :4�a.,`, she c<.r ..�ra ..: �",,'r' ' ,t1'tT'i� �i. ;. yfflo4,✓"sr,Y'e ..�.u. i, �. J:t" .4 ..�i,S _+ Address: 2 Property Tax I D#: ��` " 0 0 Lot No. Site Plan Name: �, 7 �2Q�e, /�'L.�,. Block No. Project Name: 1 FEIZ_ FIRM' New electrical Meter Second Electrical Meter '' � � q � � � " a '?-�^�` y�W r43. � �vzi �j��'m ti c".-2" L't^v s''.x•, .C. ' ¢� Additional work to be performed under this permit—check all that apply: _Mechanical _Gas Tank —Gas Piping _Shutters —Windows/Doors _Pond Z- Electric —Plumbing, —Sprinklers —Generator —Roof Pitch S !` Total Sq. Ft of Construction: 2 1 Sq. Ft. of First Floor: 0 Cost of Construction:$ �� Utilities: Sewer _Septic Building Height: 9' Na'S C.- . «� x_a... , s.�: 5». .s'�i�: Name: Address:`� �' �7l✓ A Company_: City: V ate: , Address: 01 Zip Code: __ f Fax: City:, State: Phone No( o�9-/ Zip.Code: E-Mail: Z-,O� L d 0 ��C ,7-4 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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. t 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 regbested.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 accessoN'uses to another non-residential;use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in,paying twice for, improvements to your property.A•Notice of Commencement must•be recorded in the public records of St.: Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender,or an attorne before commencing work or recording your Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder . STATE.OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF. Sworn to(or affirmed)and subscribed before'me of Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization - Physical Presence or Online Notarization . this day of ,.20 zaby this day of 20_.by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification` Personally Known OR'Produced Identification Type of Identification Type of Identification Pro ced Produced (Signature of Notary Public-State of Florida) (Signature of'Nofary.Public-State of Florida) _ Commission No. Commission No. (Seal) ypYP(, LASHAHNAINGRAM-RAHMING 3Q _ Ay CIMMISS101, i :"• ,QQ EXPIRES:Decei nber 20,2022 REVIEWS F t3QNtNf*tary F utEd f?6f % PLANS VEGETATION SEA TURTLE MANGROVE CO REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 7 - 1 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. 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 COAW 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 violat' f this exemption. Initia 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 cod , and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on how to 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 understand that if I compensate any person or company for work performed they are required to b licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable for cost of the license. Initial 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 medi 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 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 Departme to the Florida State Department of Professional Regulation. Signed a d a owledged on this f day of J N of 20 ?. Owner/Builder Signature STATE OF FLORIDA COUNTY OF SL1W� 9s�= The foregoing instrument was acknowledged before me thisP day of ,2 by who is personally known to me,or who has produced j�7L. \SS.) s as identification. Signature :,r3i 1' ': I4GRAM-RAHMIN19yp or Print Name of Notary (Seal) =.; ._ MY COMMISSION#GG2750t0o1 nission Number Title:Not 3� Ge: EXPIRES:December 20,2022 SLCPDSD via' 1 .,� %onded 7hru Notary Public UnderNdters