HomeMy WebLinkAboutPermitAII APPTICABTE INFO MUST BE COMPTETED FOR APPTICATION TO BE ACCEPTED
,^r", U, O/ro Permit Number:
t\1t{11'-
I rr Ir I lr...i]Building Permit Application /
Commercial- Residenti ,, V
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL i4982
Phone: (7721 462-1553 Fax: 1772), 462-1.57 8
Property Tax ID #:
Site Plan Name:
3jLt ,0 t' oozl - oCIo- o /co4 B51t t LotNo. Z7
Brock No. !h-39
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION I N FORMATION :
Additional work to be performed under this permit * check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Pitch_ Electric /Plumbins.
-_ Sprinklers _Generator _ Roof
TotaI Sq, Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: S Utilities: _ Sewer _ Septic Building Height:
lf value of construction is 25OO or more, a RECORDED Notice of Commencement is required.
lf value of HAVC is S7,50O or more, a RECORDED Notice of Commencement is required.
PERMIT APPLICATION FOR: W *'rEL HEATCR- R.A
PROPOSED IMPROVEMENT LOCATION :
?aqf St Lvcr L SqqsL
DETAILED DESCRIPTION OF WORK:
<o g,AL.
OWNER/LESSEE:CONTRACTOR:
Name K Cz4td Zosarc Name:
Address:
City:S/. Zctct
Zip Code: 7u?tr Fax:
PhoneNo. -77L Zt Z L+Vgb
E-Mail: C&*tcr Cu>a+o @ k(W k I L .Ar/l/.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
UPL Company:
Address:
City:
Zip Code:
Phone No.
E-Mail
State or County License
Fax:
State:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESTGNER/ENGTNEER:Y Not Aoolicable
Name:
MORTGAGE COMPANY: -_-[Not Applicable
Name:
Address:
City:State:
Zip:
-
Phone:
TEE SIMPLE TITLE HOLDER: ( Not Applicable
Name:
Address:
City:
BONDING COMPANY: -CNot Applicable
Name:
Address:
City:_
zip:Phone:zip:Phone:
OWNER/ CONTRACTOR AFFIDVIT: Rpplication 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 CounW makes no reDresentation that is erantins a permit will authorize the permit holder to build the subiect structure
which is in conflict with anv a'pplicable Home Ow[ers Ass-ociation rules. bvlaws or and covenants that mav restrict dr prohibit such
structure. Please consult with riour Home Owners Association and review'your deed for any restrictions Which may apply.
ln 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. lf you intend to obtain financing, consult
with lender or an before commencing work or recordi ur Notice of Comm ent.
STATE OF FLORIDAi6ufiiildf-"'-3:n rn:i
Sworn to {or affirmed) and subscribed before me of'j Phvsical Presence or Online Notarization*it jlij day of A-q.r: k- , 2020 by
Name of person making statement.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
_ Physical Presence or _ Online Notarization
this _ day of , 2020 by
Name of person making statement.
Personally Known _ OR Produced ldentification
Type of ldentification
of Notary Public- State of Florida )Notary Fub[c Stale of F
E!lzabeth Roberts
; Y(SiatUv comm,ss,on GGoorf*}fl Exorres 12/04/2023
ZONING
KEVIEW
SUPERVISOR
REVIEW
SEA TURTLE
REVIEW
DATE
COMPLETED
Personally Known _ OR Produced ldentification
plnnning & Ilevelopment Services Department
Building & Code Regulations
23fi) Yirginia Avenue
Fort Pierce, Florida 34982
(172\ 462-1s53
OWNERIBTIILDER Atr'F'IDAYIT DISCLOST]RE STATEMENT
F.S. 489.103 (A E)mMPTTONS
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 &e owner of your property, to act ils your own confactor eyen
thougtt 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-fami.ly 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 flray not build or improve said structr.nes 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 skte law and by county
or municipal licensing ordinances.
Initial uere, gft^O
If you sell or lease a building you have built or improved within one year after construction is complete, then a
prestrmption is created that it was built or improved for sale or lease, which is a violation of this exemption. , ^ /
Initial Here. &LL
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 codes, and
zoning regulations,
I understand that the building official and inspectors are
minimnm ggdg.
bv U<",v{t(-{ L ir, h is personally Lrnownby \{f'*lL\{ \1 .\-'' is personally Lrnown - to me. or who has
produced f\t\t?'9 L i<'e-vf>.. asidenrificarion.
Initial Here. L,"{L-{t)'
not there to design or give advice on how to meet the
Initial Here. ,f " f'
/'(-(- v"
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 attonrey. This deparment witl not mitigate any contract disputes.
rnitiar o"r*. 4/fL
I underrtand that if I compensate any person or company for work performed they re required to be licensed in thisjurisdiction. If for some reason they do trot possess a license, I may be responsible and liable for the cost of thericense. Initiar Here. M
I understand that ifany person that is unlicensed and uninsured gets injured on my construction project-they may be
entitled to worlmen's compensation. I could be held liable for all doctor, lawyer and related medical cost, which
could include loss of wages during recovery &om their injury. Initial Here. /E
To qualify for this exemption under this subsection, an own€r must 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 firther understand
&at any violation of the terms of the ownerlbuilder exemption shall be reported by the Building and Zoning
?ff ,WY f# Weparment
or Proressionar Regulation. mo *;%ry*;ruL
Signature
STATE OF FLORIDA
COLT{TY OF '-, \ l. .\.\r--\{=-\.\L-\-q, \ ( tFL.,*rl@;ir.dged berore-me tlilHigry or AU,tgr,Si . 2q+,
.LsY P!- Nola:\ Pub'rc SlSte ot trlor'da
i{i i',f"ofi[Il?"# n,,.,,u
'", j,,"f r-,otes '2.Qa 2A2't
or Print Name
Title: Notary Public
L5-