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HomeMy WebLinkAboutBuilidng PermitW/ LICABLE INFO MUST BE FOR APPLICATION TO BE ACCEPTED Permit Number: ),7 o L - os,�q RED r Building Permit Application Planning and Development Services JU� 2 j��]. Building and Code Regulation Division - 2300 Virginia Avenue, -Fort -Pierce FL-34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_ PERMIT APPLICATION FOR:tt�=5E� Address: ) a-!4 At VIAW QUE2 291�1= -Vr 2,a?c-gF4, Legal Description: L&-r 5 is,�1 S+S6DtytSlael~ P�eu�c-ems 5-1 1 .94 Property Tax ID #: 466A •'4�c>3Lot No. Site Plan Name: > Block No. Project Name: q65a064�-f RLi- ,� Se backs Front zsi Back: ibi,3s Right Side: 31,, LeftSide: Rp. X li5, Q.� amonai worK to De pe Mechanical u _ Gas Tank =. J aii tnat apply: ShuttersWindows/Doors Electric plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 454 Sq. Ft. of First Floor: Cost of Construction: $ �r- ,®mod Utilities: —Sewer "'Septic _ Building Height: NameU4 L CASE1/4i tabs IA ?Et IA.. Address: *Wb 60,Ci� S i , City: �6A.Y WC:;--v State: �- Zip Code: 3.34Vi+ Fax: Phone No. Oat.) Sot e5-t-i E-Mail: ccSv,n Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: 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. 1 I i e. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: "ft -C-7• 5ii4t► od fA . _ N;ime: Address:_ ,11'1 ibi WU;C0P 43� D•. Address: City: .6. State: . r City: State: Zip: Phone fSV- �2_r%. � 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 is in Owners Association bylaws or that restrict or such which conflict with any applicable Home rules, and covenants may prohibit 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 onAhe 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. 1 � r Si ure of caner/ Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder STATE OF FLORIDA STATE OF LORIDA COUNTY OF �I..��O,; COUNTY O The forgoing instrument was acknowledged before me The forgoing instru ent was acknowleqg6d1belfore me this day of Jylsd , 20 1 by this day of 20_ by (Name of person acknowledging) (Name of person ac owled (Signatu of Notary Public- State f Florida ) (Signature of Notary Public -State 'of Florida) OR Prd �l tion Y KN� Personal) Kn414"r-1.11 Personally Known OR Produ d Identification Type of IdentNotuy PubIIC - State..ot Florida Typ of Identification Produced COmmisslon N FF 232407 Produced yComm. Expires May 18, 2010 Commission No. BCndedthroupir E!I aryAsm Commission No. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVI W REVI W REVIEW REVIEW REVIEW 'REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014 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. 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 applic le laws, ordinances, building codes, and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on how to e the minimum code. Initial 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 I understand that if I compensate any person or company for work performed they are required tg.Nbe licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable r e cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction p ' ct- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and rel d cal 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 Zom g Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this dayof Coal of20J7 n OwnbrMuilder Signature STATE OF FLORIDA COUNTY OF 5T. L,>Cli: The foregoing instrument was acknowledged before me this day of �C� �� , 20 by hAJC1 Q INZA who is personan A-- to me, or who has produced as identification. Signature ofNotary Type or Print Name of Notary Ftoos ao. ISHMAN Title: Notary Public Commission Number Notary Public - State of HOME •E Commission # FF 232407 My Comm. Expires May 18, 2011 SLCPDSD Revised 05/152lowr 014 w�.r.� -• w,...�.ea s All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: a Permit Number:,51 04 — bSVY Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Building Permit Application Commercial Residential IXERMIT.APP.LICATION FOR:KeS, 4D JJcv,,;. &VU-1CO_C LWvu-'+W rai/m r,Z' K1.gV LVW�-v u-•TJ"n.ill K 'Rt,.M IIU dJm. oera ?AT i'i `I�¢la��}G /F �7fl�l�� % IF�wFI ! SK �13� I r�%<8,� 1 Address: iZ Yll .5. -r vb, 44) Ai�cM Legal Description: 1414, -SIbIf Property Tax ID #: ���� dd BF%%b Obi %'?� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: ditional worK to be pertormed , under this permit- check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ IAS NC CGo'O d Utilities: _Sewer _Septic Building Height: WE N':IERAME, I C(?NTRAC OR. Name rQt U ?&AS Name: DMte& f,,1A Address: Company: A) . City: /AD V y k)DM') '41- '33bolI State: Zip Code: _�307'1 Fax: Phone No. 7e4 -'3DZ 06'61 _ Address: /YZT <0;A0 ,WA City: J�-" 'DLZ&-4-eg State: % Zip Coder Phone No 1-77.- E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mailer eDf� Q m h A) -, State or County License C! Rd_ If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUF'PlEMENI"AL CC?NS�TRUCTI© LiN LAW IN WE, MA DESIGNER/ENGINEER: Name: Address: City: Zip: Phone _ Not Applicable State: MORTGAGE COMPANY: _ Not Applicable Name: Address: . City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Not Applicable 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 commerKing work or recording,your Notice of Commencement) , kt&eof tggn wner/ Lessee ontractor as Agent for Owner Signature of Contractor/Lice se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S>r. L\)cl, _'� COUNTY0F4+. V--,;�le%e The forgoing instrum nt was acknowledged before me The forgoing instr me t was acknowledged before me kJ this �_ day of 061 20t7 -- by this day of d20AI 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 �' 1 flU Produced TrL J)L- r ANNAMARIE Ul�1EP•1S (Signature of Notary blic- State of Flori . a2, G VENS -�?(Signature of No r state PT&ta . = NCO '� D�NNAMARIE SSl1;'GGe-2 � � 7 Q2 Commission No. 3 ': ( rgpNlfdl y ate ;k EXPIRES: Puol,c Under rite 1 iy, S' ; n adl'hn tioaty J.. No. 1- DecYpub!";Unclerurit"°•� .a; No;2n P_ .wmmission =, ; .•off, Bondedl"hni REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 NO V 2 72017 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner, anthe new contractor of record for the current permit. A new permit application must also be completed with new contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to commencing any work. There is a $50.00 fee for the Change of Contractor. CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be signed by the general contractor only. The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and subcontractor. There is a $50.00 fee for the Change of Sub -Contractor. CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: 27 r Permit Number: ob — os?l Site Address: /dT)44 %�1d IAW ) State License SLC License Original GC, subcontr cto(ar or owner/builder/� &94W7j- vd, NUCeaiftAtate License O& 01.5YZ7 SLC License 43 New GC, subcontractor or owner/builder Reason for Cancellation The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all costs, fees of damages arising from any and all claims of action for any son, which may arise as a esult of this change of contractor/subcontractor or cancellation of permit. A permit cannot& ncelled; f vyovk has bee performed. SIGNATURE OF OWNER (or owner/builder) PRINT NAME State of Florida, County of St. Lucie County The following instrument'was acknowledged before me this day of 20_, by who is personally known to me or who has produced as ID. Signature of Notary Date Revised 05/18/2017 TURE GENERAL PRINT NAME new GC, as e6 6ea, 'Qf State of Florida, County of St. Lucie County The ollowing ins�ument was acknowledged before me this � day of N OJ 20-U byDq-u a--�C i % s: , k a n who is personally known to me or who has pr ceii L 1- as ID. Eli. Signature of t8':ililkdlSSION # G EXPIRES: December I 2020 1 Motaq Public Unuenrnfe's oC° Bonded Thor y ST. LUCIE COUNTY BUILDING & ZONING 2300 VIRGINIA AVENUE FORT PIERCE, FL.34982-5652 772-462-1553 FILLEWLA"- 8 -A - - - A- - - I, the undersigned, am the owner of the following described property- �-Sc54•�3-co(�-�i-2.��5 M��.itvas 5�►tP� �UZSf-!� 5P��1��� �rr�z �,, (Tax ID/Legal description/Address) for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , I acknowledge that as owner of the above described property, and, in accordance with Section 7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring adequate drainage so that the immediate community WILL NOT be adversely affected. I further acknowledge that in granting this permit for the development of this property, St. Lucie County is neither obliged nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community. L-4; Property Owner Name Property Owner Signature Date STATE OF FLORIDA, COUNTY OF1 S71 LOe-15 ACKNOWLEDGED BEFORE ME THIS _ DAY OF �J �� 20-V BY &VA. ea& WHO IS PERS Y KNnwrt TO ME OR WHO HAS PRODUCED AS IDENTIFICATION. j;-a-9 SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY - NOTARY PUBLIC TITLE ROBERT G. ISNMAN Z NOtuy Public - State o1 Florida • = Commission N FF 232407 O My Comm. Expires May 18. 2019 Bmft ttro* National Notary Assn.