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Alf APPLICABLE INFOMUSTBE COMPLEFED FOR APPLICADON TO BE AC{IEPTIED � � +� �- ' C 5cf
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Building Permit Application
r and CadirAeVOaftaow on Commercial Residential
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PERMIT APPLICATION FOR. Feel4r
Address: 10301 S �►- a� P s s FL +' "T ; Z-
ProWrty Tam I D a- Lot No
Site Plan NtnW .— r&Z
4"M _ � Block
CC,,►�o
Project name +efA,�&.
Hew Electi cal Meter 1 .1 Se+on�nd Eietlri al It�t+ete+ —
Additional work to be perfarmed tstdertNs perrnrt - check aklthat apply
.Mecharmical _G.UTank —Gas P.p,ng _ Shutters
r Electric — Plyrnp — Spn+kitfs
Taal Sq Ft of Construction
a
Gator
Sq Ft. of f+eyt Floof-
W-ndov"IDoors — Pond
Root Pi tch
Cost of Constructor! 5 1400 Utilltres: —Sewer _ SeptIc Binding Heigist-
Name
Address: Io?oJrFsr+' Xsais Conrparry:,
City: r IP-Sf Stile. F< I Address.—
tipCode- Fax - _ 1 City Star
Phone No _ I ID f 7Y t 1410 LIP code. Fax
E_ma& bIo%rkeAn LX-& smo,ieon. Phovse NO --
Fill in fee simple Tide Holdtr on r*M p Ke I if different E-Mail
from the Owner listed abovel State or Countw Li€enw
1f va I ue of constr uman is ZM* or more, a RECORDED notice of Coctm+erKgRKnt 4 rexxuked.
if aal ue of HAVC is 57,5W or mare, a RECORaEO Motive of Conwmeaterv-keM rs rttquiotd-
DESIGNER/ENGINEER: JX Not Applicable
Marne:_
— —
exddress:
City: _
Zip: _ Phone_
FEE SIMPLE TITLE HOLDER:
Narne._
Address -
City._
7ip;
_ Phone
State
`XC Not Applicable
MORTGAGE CGMPANY: X Not Applicable
Name:
Ad dress
City. State:
ZLP; Phone:
BONENNG COMPANY: Not Applicable
N.3 me
Addtc-�s
City:!
Zip: _
Phionr-
OW N E R/ CONTRACTOR AFFIUViT: Aplpkat-on +s hescby nNW to tlbtAM a IRtrmit tlx do the work and installaTron as indmcau,d
I rertl ly that no work or mnstaUtion ha-s Comt+ n"ced prior to the issuafte of i permit.
St. Luce County m;kes no representation #hat is granting apermit wdl iuthongethe permit holder to buii¢ the subject VructOre
which is in con Plict with any appkaVe Home Owr%ers Aks;Ktjf wm rules* bylaws or and covenants that may rcstrkt or prahibrt sur I,
structure Please consult wrth your Horne C wnm Assoc�atkon and re,rrew your deed 10r any restrwL140ns whrth may apply.
In consideration of the granting of thl!i, reQuested plrrnit, I do hereby dtipee that I will, in J11 respe€ts, Worm the work
in xcardance with the approwed plans, the Ftord,a Nilding Cod#iand St. Lucia County Amerrdments
The folle„r,ng building pvrrr pt ppphcatlon-.arp exwnpt from umdergnrrrg a full concurrency revww loom add lrrons,
JcceSSorV itr,,cture,,, %WirFlming poc,!S. fem r# wdllt t Pnti. wCFPPn rocirr ,% and JKCesiary U}p3, #o angther non residentmal use
WARMNG TO OW RER: Your failure to Record a Notice of Commrreetcement maV result ire paying twice fOr
improvements to your property A Notice of Cornmencernent must. be recorded in thi� public records of St
Lucie County and pasted On the lob site bef0re The fpfSt rnjpeCtion - If you intend to obtaen financing, consult
with lender or an attorney before commencing work of recording your NotiCc of Commencement.
pAn.� 7 -D 4 CL, '— ---
SIgn,j%rr. of Owner/ LesseelContrxtor az ►tigonr for Owner sagoaTure of Con racti:W&Kenst Kci4der
STATE OF FLORIDA f STATE OF FLORIN
COUNTY OF S Ir` L y COUNTY OF_
5,uor l io for afflf,re•dI and subscr,bed before me of
_ Physttal Pre nce or ,_ 0nlmr►e No1AF1jJ?t n
this I!- day of 15t+90--A- 20LL Cy
ALA K envaw4tCAP
Narne of perwon making st.etrrronl.
Personally K"%vn _ OR Produced ldentAcat
Type of Iderktlfic,kttrsn
Pm4Wgd- ter
Sworn to (or ifirm led) arrd subscribed Mare me cf
_ Phvslcil Prewacror _ Online Notarization
INS day 01 . 213: by
1 Name of peryon making statemem
fanrsa.natiyl l[now+, t]R prose,€rd Ider,tltic32ran
Type of mdene-flca:lon -
Produced
,ire of NO
'�Ldnature of KOUIF� Pubk- Stitt 01 Fk"a 1
tirkarr r
Commission No.
*sue* .�rqr e:�z�
am"Wsseon ilo. SeaiI
7--
REVIEWS FRONT
ZONMG SUPERVISOR
PLANS
VEGETATION SEA TURTLE MANGROVE
I
WUNTER
I REVIEW
I REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATA
-
ft�CE11lED
DATF
COfNP�.ETfE)
I
97. E
Planning & 11)"clopmeot tirriices Department
■ Building & t-udt Re-gulaiiow.
tM %'irpms Al raur
Frrr rKrrsr, florid■ 82
1"21462 1111
OWNEIUBUILDER AFFIDAVI'i' DISC DSURE STATEMENT
F.S. 499.1031') # %VMP'T1ONS
State lau rewires connyuction tv be done b-w luxnsed contractors- You have applied for a permit under an
exemption to That law The cxemptton allows you. as ilie owner of yoitr property, to act as your own Contractor even
though you do not havir a license:. You must provide direct; cn-site supmision of chi t:onstruction yourself. You
may build or impnaue farm outbuildings, a onc-family cc u-family residence for your use and occupancy You
may also build or improve a c,�mmercial buiIdtrig at a cos[ not exceeding 575,000 00 as fang as it is for your owrl
U-SC Of occupaney You may ci[it build or impro'.e ,wd structures for the purposes of sclfing or Iming that building.
You may not hire an un11=sed perwn to act: as your coartrjKw or to supmiSC people working on your budding; it
is your responsibiIity tQ make sure that people employed by you ha4wc iicenws rrquircd by scare law and by county
or rnunicipal iicensimg ordarianccs
Inilisl Here. 0M
If you soil or Icau a building you have butte or in reved within one Xcar afCer construction is complete, ihcn a
presumption is created thal it vwils biti11 or improved for We or Ic&w, which is a Violaliortafthis excrnpti-Dn.
Inillltl Here.
You may not deILgaie (he responsibi I iTy for %upcmising work to a licensed canuactor who I not Iicetased to perfonn
the work bei(1g done. Your construrtion rn-rst comply with all appl4cablr Isws, ordinances, building codes, and
zoning regk4lmi nr - initial Iltre. s't
f understand that the building official and inspectors tie not there to design or give advice on how to meet the
minimuni code Itulial Here. B
f understand ihat es an owner•builder that any wniract disputes with sub-tontrzKMrs and f must be handled in a civil
court with the advice of an attorney This depament Kill nit mitigare any contract disputes
Initial Here. /1,
1 understand that if I compensate any person or company for work performed they are required to tlx liccrotyd in this
junsdictian. If for same reason (hey du not possess a Beanie, I may be responstbie and liable for 4hc coat of the
license Initial Here -
I understand that if u1} person chat is unlicensed rid uninsured gets injured on my construction prolw 4cy may be
t:ntaled to workrnen's compensation. I Unild be held liable ror all dfoctor, lawyer and related medical cost, which
could include foss of wags diinng recovery from thctr injury. initial Herr. k
To qualify for this exemption wider this subsection, an owner must personally appear, sigh the building permit
applicati-on, and initial the atbo+ve
I hereby acknowledge that I have read and understand the above disclosure stalcmem and that ( further understand
that any violation of the terms of ncc owner+builder exemption shad be rcpurtcd by the Building and ZOnin
Dcpartmeni to the Florida State Departrrienl of Profesmonal Regulation Signed and aeknawledgeil on this
day of :�kAva€ I of 20'L t
f
CMrrerT3ui1der Signature
STATE OF FLORIDA
COUNTY OF L c , �
Tide foregoing instrument was acknowledged before me this Z 7 ,fay of A NV%Y 20 .
kv i J4hC i}} I ?O who is personally known bl to mc, or who hm
produced _ as identification.
J It 40AI
Sr t,re o Nora,y Type or Print Marne of Not;,"
Tile' No F Commissm Number _ �q0
RWyan duon
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