HomeMy WebLinkAboutBuilding Permit Package All APPLICABLE INFO M UST-BE.COMPLETED FOR APPLICATION TO BE ACCEPTED ^ �t
Date: Permit:Number.
RECEM>
JUL 14 2020
Building Permit Application ST. Lucie County, Permitting
Planning and Development Services
guilding.and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: 1�N
Address: ) L 3
Lot No.
Site Plan Name: Block No.
Project Name: CQi
V o
c x
i
New en Ye Mger Secon�rical . eter
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:
Cost of Construction:$ Q L Utilities: _Sewer _Septic Building Height:
4..rs^-.��'-"+'^� "�i'- aY. 'S'^ ...v tt s^�:,.a�'iT' ..� .+ w�..�.ec� �+ � --. +?" -7t '•"W `�.^,�.ss�c '�";;33 s""
-c�`> w�:+�.:�.."� � ���.�'.,. � 1 m;1�e4a.-�-.,.'s�.�xa,.�.-.s"�•.'i.a. "'+ .fi'` :�.ti'��=''A.._��vL'r`'..- �m....xE- ..r_-.:c,�.�C..a� ,..��`�_^.'s`._".
Name. 'i Name: UDMe,
Address: l Company:
City: '\ State:_ Address
Zip Code: ?5�-el S� Fax: City: Stater
Phone No.- Zip 1 /� Zip Code: 31 �� Fax:•
E-Mail: �&S YYl I '1��.(� qMQa hone No `�� 1 qO Ql`g
Fill in fee simple Title Holder on next page if different E-Mail -e S� )�� �Cc-) 1 < <
from the Owner listed above) State or County License�g
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.
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: State:
City. State: City.
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.
commenced rior to the issu ance.of a permiL
certify that no-work-or installation has p
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 consultwith.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 concunency'review:roam 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
itnprovements 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 attorney before commencing work or recordiri . our Notice of Commencement.
older .
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/license H
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
Ph sisal Pres nce or Online Notarization, Physical Presence or Online Notarization
this day of 20720by this day of ,20_ by
In�,ll(e C ' Ym 0 �11
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 J Produced'
(Sign ture (Signature of Notary Public-State of Florida)
P�n, KAREN S. NIELSEN
�P 4°��;State of Florida-Not eal blic Commission No. (Seal)
Commissio � . � j'
_* ommission # GG 207484
%9. P My Commission-Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Emig
Q Planning&Development Services Department
Building&Code Regulations n
2300 Virginia Avenue R E C E I`� Ic
Fort Pierce,Florida 34982
(772)462-1553
JUL 4 2020
OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S.489.103(7)EXEMPTIONS ST• Lucie County, Permitting
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 Here.1 i�
If you sell or lease a building you have built or improved within one year after construction is com lete, then a
is create
P
presumption d that it was built or improved for sale or lease,which is a violation of this exemption.
Initial Here. A
with 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 w all.applicable laws, ordinances, building codes, and
zoning regulations. Initial Herer
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.
i
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled a civil
court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial Here.
�j�
I understand that if I compensate any per
son or co
mpany an for
work performed the
y are required to be licensed to 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.r e ,
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, w
could include loss of wages during recovery from their injury. Initial Here.
To qualify for this exemption under this subsection an owner mu
st st 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
Departm nt to a Florida State Department of Professional Regulation. Signed and acknowledged on this 3
day of of Mao
STATE OF 171,7� Owner/Builder Signature
COUNTY OF
The foregoing ins nt as ac cwled ed efore me this day of 20 �
by who is personally known tome,or who has
produced as identification.
Signature of otary t Name of Notary Seal
Title:Not (Seal)
KAREN S. NI Cbg ssi Number
?ro'PRYP�e��,State of Florida-Notary Public
_. Commission # GG 207484
9rFol;oP My Commission Expires
June 12, 2022
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