HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ����
Date: Permit Number:
ozb
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: fl W o o A A ek s V r `� �(y�cy� cle ! Z"
Property Tax ID#: / Lot No.
Site Plan Name: Block No.
Project Name:
o.i��„ 51..;...a�CS a•�d yvnxky r\ vs64t, jN1 u
3
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _$W000R o o f S/I Z Pitch
Total Sq. Ft of Construction: 4000 Sq. Ft. of First Floor:
Cost of Construction: $ 100oo Utilities: —Sewer —Septic Building Height:
Name -r—C 1A Name: 1.••+U- %A•
Address: "70k0 Company: "Ome. 0uJvte'r
City:Vo;7An ?•'CtC State: Address:
Zip Code: Fax: City: State:
hone No. (a 7 06 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Ti tile Holder on ne 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.
Ally
Planning& Development Services Department
'COUNTY 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 ounty
or municipal licensing ordinances. Initial
If you sell or lease a building you have built or improved within one year after cortruction is
complete,then a presumption is created that it was built or improved for sale or lease, which is aricensed
f
this exemption. Initia
You may not delegate the responsibility for supervising work to a licensed contractor who is n
perform the work being done. Your construction must comply with all applicable laws, ordinances, buildi des,
and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on h eet
the minimum code. Initial
I understand that as an owner-builder that any contract disputes with sub-contractors and I must Keha led
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 req it be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and li r the
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construct n pro'ect-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate ical t
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 e 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
3 day of noksoi of 20_2,N,.
)On rBuilder Signature
STATE OF FLORIDA
COUNTY OF S (a�
The foregoing instrument was acknowl dged before me this day of ,20!�L ,
by LP,p ��(� who is personally known o who has
produced o( as identificat
ELLEN VAUGHN
?°tP State of Florida-Notary Public
c
E—` 1/
��4►1 .� ✓ ® Commission #
g �Y YP °PQ M��r�missionGExp�®S9
Signature of Not Type or Print Name of Not Ylo`Idm 22, 2 Expires
Title:Notary Public Commission Number
SLCPDSD Revised 02/7/20