HomeMy WebLinkAboutContract_20200803_0001All APPLICABLE INFO MUS BE COMPLETED FOR APPLICATION TO BE
Date:
Planning and Development
Building and Code Regulac
2300 Virginia Avenue, Fort
Phone: (772) 462r1553
PERMIT APPLICATI(
Building Permit
Commercial
:e FL 34981
(772)462-1578
Number:
tion
Residential
Address: 1 F� `'
Property Tax ID #: I 6"o aLi--0bbr7 Lot No. 9
Site Plan Name: Block No. I
Project Name:
DETAILED DESCRIP ION OF WORK:
New electrical Meter Second Electrical Meter
CONSTRUCTION IN MATION:
Additional work to be pei formed under this permit- check all that ap ly:
Mechanical G sTank _ Gas Piping _ Shuttrs —Windows/Doors _ Pond
Electric lu bing _Sprinklers _Gen ra or _Roof Pitch
Total Sq. Ft of Constructi �q Sq. Ft. of First Floor:
Cost of Construction: $� A 7�� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONT
O.R:
Name 4
Address:
City: �/C2.
Zip Code: 3Ny -2-
Phone No -772
E-Mail.4 i'r cqz>`G/1i
Fill in fee simple Title Holder
from the Owner listed
is l
Name;-
Company
Address:
City:
Zip Code:
Phone No
E -Mail
State or C
. r ., rl lye
�iA A✓G
State: FL
Fax:
93/4,
State:_
Fax:
u ty License
MGLti.Gor�I
on next page ( if different
b ve)
If value of construction is 21001or more, a RECORDED Notice of Commencement js required.
If value of HAVC is $7,500 olr more, a RECORDED Notice of Commencement Islreduired.
Planning & Develmnt Services Department
Building q C de Regulations
2300 i nia ..Avenue
Fort Pi4reeJ Florida 34982
1 hereby a kn )wledge that I have read and understand the a )oi e disclosure statement and that 1 further
understand that an vicilation of the terns of the owner/builder exem 3ti4n shall be reported by the Building and
Zonipa De I art nt to lie Florida State Department of Professional R(gu ation. Signed and acknowledged on this
�� day Qf of 20e,:nL.
STATE Of FL )A
COUNTY F f[j1l
The fore o ng ins t was acknowledged before me this �_ day f 20_x,
by who is personally k iovnto me, or who has
p uced a i identification.
0 .tee.
e o No Type or Print Name of No ti
? N lCe�ICFANlE10NN5
Title: of blit Commission Number SO y Irn,(IiC - State or Florida
„a, W. CUmm(SSIpn M GG 248504
SLCPDSD Revised 02n 0 MYcomm. E■pins AuB tq, 2022
OWNERIBUILDER AFFIDAVIT DISCLO
STATEMENT
F.S. 489.103 (7) EXEMPTI
N
State law r
-qu
ires construction to be done by licensed contrac
or
You have applied for a permit under an
exemption to that ]a
w.
The exemption allows you, as the owner of you
p
perty, to act as your own contractor even
though you do not
iay.-
a license. You must provide direct, on-site si
tpeivision
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 ori
np,
ve a commercial building at a cost not excee
in
$75,000.00 as long as it is for your own
use or occupancy. You
may not build or improve said structures for the
p
oses of selling or leasing that building.
You may not hire a
i unlicensed
person to act as your contractor or to
p
rvise people working on your building; it
is your resonsibilil
y to
make sure that people employed by you have
is
nses required by state law andby county
ormunicipailicens'
ig
ordinances.
Initial _S
If you set
or
lease a building you have built or impro
ed
within one year after construction is
complete, Then a p,eslimption
is created that it was built or impro
ed
for sale or lease, which is a vio�tion of
this exemption.
Initial -1 L5
You may T
Dt delegate
the responsibility for supervising work
D a
licensed contractor who is not licensed to
perform the work b
4ng
done. Your construction must comply with al
ap
3licable laws, ordinances, buildin odes,
and zoningregulati
ns.
Initial_
I understat
d that
the building official and inspectors are not t
tert
to design or give advice on how to meet
the minimum code.
Initial 'fiLs
I understardthatas
an owner -builder that any contract disputes
'th sub -contractors and I must be handled
in a civil court with
the
advice of an attorney. This department will not
mil
'gate any contract disputes.
Initial �L
I anderstai
d I
hat if I compensate any person or company I
Dr
Nork performed they are required to be
licensed in this juri
is
ion. If for some reason they do not possess a literate,
I may be responsible and liabl r the
cost of the license.
Initial
I understai
d t
iat if any person that is unlicensed and uninsu
ed
gets injured on my construction project -
they may be entitlei
to
workmen's compensation. I could be held Hal
le
or all doctor, lawyer and related m� dical
cost, which could i
lu
le loss of wages during recovery from their inju
y.
Initial L
T9 qualify
for
this exemption under this subsection, an owner
lnua
personally appear and sign the building
permit application a
id
nitial the above
1 hereby a kn )wledge that I have read and understand the a )oi e disclosure statement and that 1 further
understand that an vicilation of the terns of the owner/builder exem 3ti4n shall be reported by the Building and
Zonipa De I art nt to lie Florida State Department of Professional R(gu ation. Signed and acknowledged on this
�� day Qf of 20e,:nL.
STATE Of FL )A
COUNTY F f[j1l
The fore o ng ins t was acknowledged before me this �_ day f 20_x,
by who is personally k iovnto me, or who has
p uced a i identification.
0 .tee.
e o No Type or Print Name of No ti
? N lCe�ICFANlE10NN5
Title: of blit Commission Number SO y Irn,(IiC - State or Florida
„a, W. CUmm(SSIpn M GG 248504
SLCPDSD Revised 02n 0 MYcomm. E■pins AuB tq, 2022
SUPPLEMENTALCON
TRUCTION_LIEN LAW INFORMAT
DESIGNER/ENGINEER:
_,NotApplicable
MORTGA
Name:
STATE O
Name:_
Address:
COUNTY OF
Address:
City:
State:
City:
_
Zip: Pho
a
Zip: —
FEE SIMPLE TITLE HO
)ER: _ Not Applicable
BONDINI
Name:
2resence or Online Notarization
Name:_
Address:
Address:_
City:
Name of p
City:_
Zip: Pho
a
Zip: —
OWNER/ CONTRACTOF
A FIDVIT: Application is hereby made to obtai
1 certify that no work or inst Ila ion has commenced prior to the issuance of a
County no r
sentation that is granting a permit will author
St. Lucie makes pr
which is in conflict With any ip licabie Home Owners Association rules, bylaw
structure. Please consult wirl
h y ur Home Owners Association and review you
In consideration of the gran ing of this requested permit, I do hereby agree tt
in accordance with the appr
we plans, the Florida Building Codes and St. Luc
The following building Perm
t a 3plications are exempt from undergoing a full
accessory structures, swimr
in pools, fences, walls, signs, screen rooms and
WARNING TO OWNER
Yur failure to Record a Notice of Comment
improvements to y
u property. A Notice of Commencemen
Lucie Count and p
st d on the jobsite before the first inspe
.:.L L....1...
nmmonrina wnri[ nr rPfnl
Not Applicable
Not Applicable
to do the work and installation as indicated.
permit holder to build the subject structure
Id covenants that may restrict or prohibit such
for any restrictions which may apply.
II, in all respects, perform the work
ntv Amendments.
Tency review: room additions,
ory uses to another non-residential use
it may result in paying twice for
it be recorded in the public records of St.
If you intend to obtain financing, consult
vnur Notice of Commencement.
YYIVI IGIIV GI VI VV •v ..�. r�.•�. �. vv......... �... ..
Signature c
f C
ntractor/License Holder
ow/Lesse/ontraac ent for Owner
STATE OF FLO
STATE O
Fl
ORIDA
COUNTY OF
COUNTY
01
Sworn to (or affirmed) an st.bscribed before me of
Sworn to (or
a
Irmed) and subscribed before me of
Phys' l Presence oi Online Notarization
Physi
al
2resence or Online Notarization
this day of 20(90 by
this —day
f 20_ by
_rrGe U I
Name of p
!rsi
in making statement.
Name of pel I, aking s at ment.
Personally Known R Produced Identification
Personally
Kni
fwn OR Produced Identification
Type of Identification
Type of Idi
nti
(cation
Pro ,•'t✓�h'Z, STEFANIE JOHNS
Produced
ry lic - State of Florida
Co Ission M GG 248501
n
(Signature
of
Notary Public -State of Florida)
(Slill of No ry Pub is
Commission No. Uy (Seal)
Commissi
n Ii
o. (Seal)
REVIEWS
FRONr
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUN ER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. S/b/LU