HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETEG'FI
Date: 6 Q41, n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: -
Address: I ) .-�
APPLICATION TO BE ACCEPTED
Permit Number: iu)s-0 5S�
RECEIV'-:D JUN 926 W7
Building Permit Application
Commercial
P, e,
Residential
3"/ 7
Legal Description: \1 3`I 40 S `/Z Nr SW Vq kt-'S Sa 3d+�
UI 6 ( 4- 15D4 Znol)
Property Tax ID #: 1d 1 I 2\\ - 00k L) - Ooo - 7'1`1S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: 61 Right Side:z Left Side: -
DETAILED DESCRIPTION OF WORK:
;X a�J�J- WdC� 3 2
T
ional worK to oe pertormeo under tnis permit - cnecK all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNE'R,?MSEE::
Name
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
_ Roof Pitch
a
�d0' Utilities: _Sewer _Septic Building Height:
Address:
City: F')rl Q"ULQ- State: +L
Zip Code: Fax: Nib
Phone No. `rl o j
E-Mail: I (1-.APrC.S I-l-'v & il,, 6,-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
►FTiit_
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR TION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: _C Not Applicable MORTGAGE COMPANY: IC Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI A
COUNTY OF S_Jr � I.W t i'k
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
thisaday of -J S h* 20_12 by
The forgoing instrument was acknowledged before me
this day of 20_ by
Y".' ywc,v1 \ I- �6 kA
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Pub"A- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identificati
Personally Known OR Produced Identification
Type of Identificati IEGNENS
Produced oEANNAMnR
SI - # GG t122023
EXPIRES: December 16, 2020
E
Commission No. XPIRE�rcunderwrters
Type of Identification
Produced
Commission No. (Seal)
G�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
RE IEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
*RECE1V':_D JUN 26 2917 0
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNERBUILDER 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.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. 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. 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 E
I understand that the building official and inspectors are not there to design or give advice on how to meet
the minimum code. Initial "e
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 b�
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
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, which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection, an owner must personally appear and 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 owner/builder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
k day of of 20.
OwnerBullder Signature
STATE OF FLO DA
COUNTY OF'N 1iJ SL
The foregoing instrumentw�s acknowledged before me this • day ofy r.t , 20�,
by Vt: h,_-Q,"V\ who is personally known to me, or who has
produced V ` as identification.
•'i+�%""• DEANNAMARIEGNENS
MY COMMISSION # GG 022023
Signature of No Type or Print Name of No ` io EXPIRES: Deceg@Al 2020
Title: Notary Public Commission Number : , ' Bonded Thru Notary Public Underwriters
SLCPDSD Revised 05/15/2014