HomeMy WebLinkAboutbuilder permit app.SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Address.
Name:
City:
Address:
ZIP: Phone
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable BONDING COMPANY: Not Applicable
Address:
Name:
City:
Address:
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 Count
yy. makes no representation that is granting -a permit will authorize the permit holder to build the subject structure
wM-cch isiri cco'ntlict 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 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 dr an attorney before commencing work or recording, uniir Kl +i e o
Sjgnaiu�r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swop to (or affirmed) and subscribed before me of
✓ Physical Pr 7yc or T Online Notarization
this day of 2020 by
Name of person makings ment
Personally Known OR Produced Identification
Type of n ' ication
geeX - <—)
Commission
REVIEWS
� CoilxnbeiontOG}�
F ws 77DTpal)
FRONT I ZONING
COUNTER REVIEW
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 Identification
Type of Identification
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
SUPERVISOR I PLANS I VEGETATION I SREV EWLE MREV EWVE
REVIEW REVIEW REVIEW
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I Ir�LL `
Lam• J,
e L ` ` � 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
2—
Additional work to be performed under this permit —check all that apply:
Mechanical
_ Electric__
_ Gas Tank
_ Plumbing-
Total Sq. Ft of Construction:
Cost of Construction: $ 70(o
— Gas Piping
Sprinklers
Lot No.�Q
Block No. KL
Shutters j L Nindows/Doors _ Pond
_ Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name
Name:
Address: Q�
City: �CSL State: _
Zip Code: 345�52' Fax:
Phone No. ( S
Company:
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: . C nv n
Fill in fee simple Title der on next page ( if different
from the Owner listed above)
If vafna of .•....�.....a:..� :.. xnn __ �___
E-Mail
State or county License
----•---•�•• ...... .........a, a n—w—Lu :vullue or Commencement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
LUML
w�
P 0 j 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 county
or municipal licensing ordinances. n
Initial Here.,
If you sell or lease a building you have built or improved within one year after construction is complete,thena
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. A
Initial Here. 616
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. Initial Here. & 6
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.
6.
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. pp
Initial Here 4D'
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 for the cost of the
license. Initial Here. Ab
1 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 Here. �-
-- — —To qualify for this exemption underthissubsection, an owner musl personaify appear, sign the- uilding 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 Zo
Depart t e Florida Stat Department of Professional Regulation. Signed and acknowledged on this
day of W of 2
Oar/Buis Signature
STATE OF FLORIDA
COUNTY OF /l
The fore ' ins ment ac >�,owledged before me thiJv day of �, 20&,
by ^� who is personally known to me, or who has
pro ed as identification.
Print Name of Notary `.....`.4Seal lµGELNO JEWNS
sion Number Coarsission I GG 207432
o� EV&u AM 15, 2022
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