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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: 1 . 'a:1 Permit Number:
RECEIVED
Building Permit Application MAY 17 1011
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 5t,Luck Coun
Phone: (772)462-1S53 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address:
Property Tax ID #: VA\6%r S VS'CIO, bdd -3 Lot No.
Site Plan Name: Block No.
Project Name:
V. e
S
-0 11000.110W
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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:. C�� !� Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer ,Septic Building Height: Sri
•4'Wi
•-„teME
=
Name Name:
',.Address:. ..; -
Zip Code Fax: City: �' State:
Phone No. 57o I cl3 5�2 Zip Code:;-,.,'--':'-_ Fax:
E-Mail: L Phone No
Fill in fee simple Title Holder on nex page(if Afferent 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.
CgI!I
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 J 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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION_ IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee ontractor as Xg4nt for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNT(OF S*. 'L-o�'�� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 'i4\0.y 20� by this day of 20_ 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 Produced
(Signature of Notary Pu (Signature of Notary Public-State of Florida )
,S'p.Y'a�••., DEANNAGF
I�,
Commission No. .Notary Pyc�r)l
=y a Commiss��hN1 Commission No. (Seal)
My Comm.Expire
REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE N421RECEIVED
DATE
COMPLETED
Rev. 211119
O Planning&Development Services Department
• • Building&Code Regulations RECEIVED
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553 �Q� 2��1
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT permitting Department
F.S.489.103(7)EXEMPTIONS St.Lude County
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. �C c
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. C
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, 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 meet the
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 civil
court with the advice of an attorney. This department will not mitigate any contract disputes. 4-,� n
Initial Here. ,�—�iL
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 Here. pc
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 Here.
To qualify for this exemption under this subsection, an owner must personally appear, 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 Zo m
Department to the Florida State Department of Professional Regulation. ed and ac owledged on this
day of C)j of 20 1.
Owner/Builder tgnature
STATE OF FLORIDA
COUNTY OF .L y c re
The foregoing instrument was acknowledged before me this \1 day of y�qy ,20 _,
who is personally known to me,or who has
produced i`t 1D L as iden1 III III
4flic ky PG,,,,
��q I;v�� =o� eG: DEANNAGIVENS
G No�ry Public-State ofJnd8 Commissi X t oofSi ature of Not T e or Print Name of Not OF °4` MycoBonded th,, ti, Jan 2Title:NotaN Public Commission Number�-F1.1CS�C gh National�Jota
102 SOUTHEAST PRO . AVENUE, PORT
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Permitting Department
AERIAL PHOTOGRAPH
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LINE TABLE A a
BEARING LENGTH
L1 .N41°14'00"E 85.00'
CURVE TABLE CHORD CHORD WELPT-0 FfOU.0 L:3'j
LENGTH RADIUS DELTA-. LENGTH BEARING �00 1?55 \ WELL TO SOUTHEAST BOUNDARY LINE:22'±
C1 39.27' 25.00' 90000'00" 35.36' N86014'00"E ae WELL TO NORTHEAST BOUNDARY LINE:53'±
-ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED
The survey map Sc report or the coples thereof are not valid without the digital signature and seal of a
Florida licftnsied surveyor and mapper
111.,l„nn�
Date of Field Work: 05-04-2020 ,
Drawn By: C J
1eg �,�yOrG EN_'
Order*:88054
Last Revision Date:05-04-2020 - ?SM 2 d'3
Boundary Survey prepared by: LB8111U_ OF
NexGen Surveying, LLC
5601 Corporate Way, Suite # FLORIDA 103 ■/� STATE
SURVEYING• LLC.
FLORIDA
West Palm Beach, FL 33407
561-508-6272 '''A "as�mu