HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �/
Permit Number: o
Date:
RECEIVED
mm
Building Permit Application
APR 28 1011
Planning and Development Services
P�rmittieg Depar"I "
Co
Building and Code Regulation Division
St• Lu 1e
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:0—e f n z5
OSE D t U
r
Address:
Property Tax ID #: `� Di -w- ' _ __ _
Lot No.
Site Plan Name:
Block No.
Project Name:
-
-
- --- ---
DETAILED DESCRIPTION rzOF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed 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: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR:
.
Name re in Name:
Address: + Company:
City: State: Address:—
Zip Code: Fax: City: --__ --
- state --_-
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Ti e Holder on next 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 HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
AT10N�:
'SUPPLEMENTAL.CONSTRUCTiON LIEN LAW INFORMgy
DESIGNER/ENGINEER: _ Not Applical)lc MORTGAGE COMPANY: _ 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 JOB SITE BEFORE T ME F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOkui,%G YOUR NOTICE OF COMMENCEMENT."
Rev. N Q p
0
I
I
Signature of Owner/ Less /Contractor as Agent for Owner
Signature of Contractor/License Holder i
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing i tr ment was acknowledged before me
The forgoing instrument was acknowledged before me
20_ by
this�day of , 20� by
this _day of ,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
!
Personally Known OR Produced identification
Type of Identificati
Type of Identification
Produced
Produced
(Signature of "'Notary Public- Stat f I ida)
a ,:
(Signature of Notary Public- State of Florida )
_ c
�%•;;
Commission No. (Seal)
- ;:0'
Commission No. (Seal)
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REVIEWS
FRONT
ZONING
RW_S�
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
�B�/�E9UT�
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
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DATE
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COMPLETEDvO
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 b county
or municipal licensing ordinances. Initial
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 v" tion of
this exemption. Initial
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, buil it g codes,
and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet
the minimum code. Initial �s
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 -T-S
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 ,s�
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 _r
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
onmg DepartZO
e Florida State Department of Professional Regulation. Signed and acknowledged on this
o$ day of of 2019
Anu r Signature
STATE OF FLORIDA
COUNTY OF S k�
The foregoing instrument was acknowledged before me this �� day of , 20�,
by who is personally known to me, or who has
produced as identification.
i
SigNalUe c f Notary Type or Print Name of Notary H E A B U R F O R D
Title: Notary Public Commission Number ?=o,�« " State of Florida -Notary Publi
SLCPDSD Revised 02/7/20 -* Commission # GG 183217
OF My Commission Expires
///MW February 06, 2022