HomeMy WebLinkAbout6.30.20 BUILDING PERMITAll APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 0 YJ C,�Permit Number:
' Building Permit Application
Planning and Development Services
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: Felnce
W.
Address: (t f bR-4 t�
Property Tax ID #: J4 3'1 L Z 3 , �� — `� e�
Lot No. —
Site Plan Name:
Block No.
Project Name: —"'
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ce-
toe 61 ,rt3a
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New Electrical Meter AM-1- Second Electrical Meter oyhq
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Pond
_Electric _Plumbing _Sprinklers _Generator _Roof
Pitch
Total Sq. Ft of Construction: — ( Sq. Ft. of First Floor: A-?1
A
Cost of Construction: $ Utilities: _Sewer Septic
Building Height:
EMOR:
Name ' n, -
Name:
Addr s . Qc[ 'SfpnSR1l �
Company:
City2 State: v [
Address:
Zip Codek ) W49 1 Fax:
City:
State:_
Phone No.7M, 712L-3�5-30
Zip Code:
Fax:
E MaiL� @ I o
Phone No
Fill in ee s`imple Title HtAder on n//ext page ( if different
from the Owner listed abo ) Z i Ly O f
E-Mail
S e r County License
If value of construction is 2500 or more, a REC RDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or andpcovenants 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 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 our Notice of Commencement.
5t' E V1�' L� 'C�'(
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 2020 by
this day of 2020 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
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Name _ _
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Name
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ON: State:
City: State:
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I Zia: Phone
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FEE S vow 11 11- ! 'c
BONDING vF,��P��,r, 10ot AApFlitiable
Name _
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City.
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AINERr r t)!u rrtn xnp eFI.pX�ltnT: Application is e=eb
made t^ ebta;n a ermit to de the va^r end .nst=llatlen as indicated.�I
I Certify that no wor; or Mrst 11a ion has commenced prior to the issuance of a permit.
St. Lucie Countw maces no representation that is prancing a ce
nit will authorize the oermii holder to hullo the subject structure
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which is i cvivitn any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struz'u. _- .,.,,: .i t you, Home~C.°'wnerfa ss3cwbor, a,
d yuui .aci Fo 1y res',-L:tion: Y e.,..,, aidi, app"r.
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In CdnS cf anTinP of vhls requested n F!*i t, ! (]o hereby agree that i WI8!, in all respects, perform 'Che WQY!3
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h a'L'O/4_ _ ,,. rQi, _ ; to :'.ding Coles
and St. Lucie County. Amendme^ts,
_ -
ergoing a tuft concurrency rev ewr: room
ii
..� :-ooms and accessor y uses to anctrei
tl
Commencement may result in pF
pi
sricement must he loco „dell it :Ic nt it
!I
inspection it you intend to Ll _. CGPi[IJfi
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to er hf° , ad suhsrribec3 before me ou I
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nysseal Presence or f7ntine Notarization
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this of 2020 by
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WIWAM B. HYDE
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Planning & Development Services Department
' Building & Code Regulations
D it OO I U D 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 co
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 viola 'on f
this exemption. Initial Y,
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 odes,
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 TV
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 be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable r the
cost of the license. Initial C.
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 1KI
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 Departm nt to the Florida State Department of Professional Regulation. Signed and acknowledged on this
2± day of UNG of 20,90 .
ner/Builder Signature
STATE OF FLORIDA �"
COUNTY OF PO[yyt oeacY
The j4e oing instrument was acknowledged before me this 3e day of Jape, 20 4? ,
by J01,0virl B (Ae5Gr1 Tr who is personally known to me, or who has
produced as identification.
42 4qe -- W,140(y i R, Nude
Signature of Notary Type or Print Name of gotary ; � ;:'b f4x�ea1) WILLIAM F. HYDE
Title: Notary Public Commission Number (38Gr) :J, NotaryPublic-5tateofFlwida
• Commission A GG 132861
SLCPDSD Revised 02/7/20 `k�,",:` My Comm.Expires Auq 8, 2021
• BandNMrwgl,NMiowl Nolarybvi.
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ILLIAM R. HYDE
NltlyWPubR(-StateofFl&lda
OnIGG 32861 j
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