HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' ��'�--` Permit Number: Sr0%S3
- - -- — RECEIVED
- -- _ -- Building Permit Application
MAY 12 1011
Planning and Development Services Psrmitti?ig Department
Building and Code Regulation Division St.Lucie Count"
2300 Virginia Avenue, Fort Pierce FL 34982 ✓
Residential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
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Property Tax ID
Site Plan Name: Block No.
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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:
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Cost of-Construction: $ 2 I J w Utilities: —Sewer _Septic Building Height:
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Name h U Name:
Address: 2LIv C)l I Company: =
City: F'(?Cb 'Pi lG1lG� State:� Address:
Zip Code: Zing�—CS Fax: City: State:
Phone No. '1-12-` �J32'DS I�l .Zip Code: :, -Fax:
E-Mail: QP�IJ � -� C,C�In'1 Phone No
Fill in fee simp a Title itle 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.
:K a ''� W. W
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 permitJ 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 .IIOB.SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER Oki A4d=ATf®RNEY.BEFORE RECORD 1G,y,?a R NOTICE OF COMMENCEMENT:'-
Signature of Owner/Lessee/ ntrac or a entfor Owner Signature'
of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF :X- -- . COUNTY OF
The fo,-.going instrument was acknowledge before me The forgoing instrument was acknowle20ged before me
this day of Ml�� 20 l by this day of
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification V Personally Known OR Produced Identification
Type of Identifjkation Type of Identification
Produced
L Produced
I
(Signature of Notary Pub - ignature of Notary Public-State of Florida}
�" "� WEN S. NIELSEN
SPAY P�6
`11'Stat of Florida-Notary Publ c ommission No. (Seal)
Commission No. °* CoQsion # GG 207484
My Commission Expires
J
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
O 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.
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.
'Initial Here. O
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.
Initial Here.
You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perfo
the work being done. Your construction must comply with all applicable laws, ordinances, building codes and
zoning regulations. Initial Here.
I understand that the building official and inspectors are not there to design or give advice on how to me t
minimum code. Initial Here.
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled in a c' 1
court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial Here.
I understand that if I compensate any person or company for work performed they are required to be licensed in s
jurisdiction. If for some reason they do not possess a license, I may be responsible and liable for the cos o the
license. Initial Here.
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-they in be
entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical cost hich
could include loss of wages during recovery from their injury. Initial Here.
To qualify for this exemption under this subsection, an owner must personally appear, sign the building pe it
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./Si6ned and acknowledged on this
day of_MOt of 20 -2 .
:A&g, xz,
Owner/Builder Sign re
STATE OF FLOR A
COUNTY OF The foregoin 'ns ment was ackn�oQwledged before me this-�'� day of ,Mai ,
by {� who is personally known to me,or who has
produced LL r as ic)entification.
Q1 KAREN S. NIELSEN
Signature of Notary Type or Print Name of Notary :°1� e`��St g��q((FloridaNOtaryPublic
'� •_ ���'n`11.1jSsion # GG 207484
Title:Notary Public Commission Number ;�, My Commission Expires