HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� -D10 Permit Number: a<) a_(Y 3m
O"�k_W20A. RECEIVED
°`~� ' Building Permit Application DEC 0 2 2020
Planning and Development Services
�ermittt department
Building and Code Regulation Division Commercial Residentia mi ucie omry
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: 0.\
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Address: vp-h L Dv—
Property Tax ID#: �1-�C� � � ' Lot No.�_
Site Plan Name:`-)\\o ��'CT�eY P-2 Block No.
Project Name:
DETA L ®z SGR PT��O�t� OLFOTME
e
c a'N S ca` C��0 33� 3a3a,Go ��1ri�l�fsvl�
New Electrical Meter Second Electrical Meter
f " - at"' r"
CO STRt1;CTf s�NCINF®RMATION g� Tt s 3 �.,-.�1 T' ` s
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:$ \ Utilities: _ Sewer ,Septic Building Height:
.5+^ic. 0 p" t6i vfs s �s'i -y
01N N ER�LESS3E`
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Name k CS Name:
Address: 2 li2 _L Company: -_
City: I e r(!:-e State: ( Address.,::-
Zip Code: Fax:Fax: City: State:
Phone No.� Zip Code:, Fax:
E-Maik Phone No
Fill in fe simple Title Holder on neA page(if different E-Mail
from the Owner listed above) State or County License
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.
4Il'U:��1'Ir
DESIGNER/ENGINEER:R s •y' Not Applicable PP MORTGAtGE COM ANY: _ Not Applicable
Name: Name: 1�
Address: Address:
City: State: City: Gt \ State: ��
Zip: Phone Zip: Phon :-yA
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.
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 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 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 I deX or ao-a-ttorney before commencing work or recording our Notice of Commencement.
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Signs ure ow owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OFFLO.RIQA STATE OF FLORIDA
COUNTY OF s,4. 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_ 12020 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 fit- Produced
(Signature of Notar ublic-State of Florida) (Signature of Notary Public-State of Florida)
Commission No�T�aa' MpRIEGNENS ommission No. (Seal)
MY COMMISSION#GG 022023
^k= 16.2020
....oPc de NotMPublicUndaMrlets
REVIEWS FRONT LANS VEGETATION SEA TURTLE MANGROVE
COUNTE IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
v
llo [LUCE � � RECEIVED
O Planning&Development Services Department
1� , __ D Building&Code Regulations �E�.� 2 7020
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553 Permitting Department
St. Lucie County
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.
Initial Here QP
If you sell or lease a building you have built or improved within one year after construction is comple then a
presumption is created that it was built or improved for sale or lease,which is a violation of this exemption
Initial Here.
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
zoning regulations. Initial Here.
I understand that the building official and inspectors are not there to design or give advice on how t
minimum code. Initial Her
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 Her
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 c
license. Initial Here.
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 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 further understand
that any violation of the terms of the owneribuilder exemption shall�e—epo ed by the Building and Zoning
Department to the Florida State Department of Professional Regulatio : Sign and a w g on this
day of of 20aD
wn r/B der Si re
STATE OF FLORID
COUNTY OF
The foregoing instrument was acknowledged before me this a- day of t 20
by V ay'ta A who is personally known to me,or who has
produced t__1D t_ as identific
DEANNA MARIE GIVEPS
a MY COMMISSION#GG 0?2023
' \ ... EXP E December 16,202a
Signature of otary Type or Print Name of Notary :;,�o P Bondaf=ry public Underwr'bk
Title:Notary Public Commission Number