HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f ' V U
Date: Permit Number:
RSceveo
'COUNTY
(APR 2 $ 101�
Building Permit Application
Planning and Development Services Fir SLttk- c�U^Y
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: 13oi-LD01- Dub - npol C1 Lot No.
Site Plan Name:
Project Name: 's h-rd
DETAILED DESCRIPTION OF WORK:
r4i
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Block No.
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: 4q_Q sc, ,
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:"'
OWNER/LESSEE:
CONTRACTOR:
NameJ 65eph
aTfawan6
Name:
Company:
Address: cwi CArl6s Pr-
City: State: -FI—
Address:
Zip Code: _)LI Q S I Fax:
City: State:
Phone No. -D 3o a --1SC( D
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if ifferent
E-Mail
State or County License
from the Owner listed above)
It value of construction is Z500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
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 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 lender or an attornev.before commencing work or recordine vour Notice of Commencement.
v 9-
Sign ure of Owner/ Lessee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA j (y ��
STATE OF FLORIDA
COUNTY OF c>'- {-.rtJL�l`�C�
COUNTY OF
Swop -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 14- clay of 202, by
this day of 2020 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
Pr d ced
Produced
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(Signature of Notary Public- State of F rida)
(Signature of Notary Public- State of Florida )
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Commission No. (Seal)
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Commission No. (Seal)
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REVIEWS
FRONT
ZONING
PLANS PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
CDX . „
RECEIVED
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DATE
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COMPLETED
Rev.
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 ande0grtty
or municipal licensing ordinances. Initial (�,�`J'�
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 vightfiep 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 des,
and zoning regulations. Initial M
I understand that the building official and inspectors are not there to design or give advice on ho t eet
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.
Initia
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 li e r 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 rel ical
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 terns of the owneribuilder exemption shall be reported by the Building and
Zoning Departm t to th Florida State Department of Professional Regulation. Signed and acknowledged on this
k day of of 20
Owner wilder Signature
STATE OF FLORIDA
COUNTY OF 5l;L LC
The foregoing instrument was acknowledged before me this JA" day of
by who is personally known
produced DL as ider
Signature _dt Notary /
Title: No,Public
SLCPDSD Revised 02n120
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Type or Print Name o o ary
Commission Number
20_Z,t,
)r who has
�.�'r'P' HEATHER BURFORD
f' ;State of Florida -Notary Publi
Commission # GG 183217
' �y ommission Expires
"����"� bruary 06, 2022