HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit.Application SUN 1 7 202y
Planning and Development Services Sk Lucie
,Building and Code Regulation Division Per niti�g
230.0 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential `�—
PERMITTYPE:
Address:
Property Tax ID #: _
Site Plan Name: "l-'N
Project Name:
Y-4e2
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic
Lot No.
Block No. d �9
Windows/Doors
Roof Pitch
Building Height:
iDWNER�LESS€E fi_ _
CQI�ITRA�CT4R,
Name
Name:
Address: .2S S�boos�`� 4�_
Company: - .._. .
City:, �.�, c� State:
Zip Code: � S Fax: _
Phone No. v �l
Address:',
City: State:
Zip Code: Fax:
'Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different .'
from the Owner listed above)
i E-Mail
State or County License
If value of construction is 52500 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.
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 462-1553
OWNERIBUILDER 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.
If you sell or lease a building you have built or improved within one year after, construction is com�)ete h n 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 lic soh ed 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 fow 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.
InitZe
Here.
I understand that if I compensate any person or company for work performed they are required to 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.
I understand that if any person that is unlicensed and uninsured gets injured on my construction p6stt-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. InitialUere.
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 ownerlbuilder exemption shall be reported by the Building and Zoning
Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20Z
O ier/Bu' der Signature
STATE OF FLORIDA�-
COUNTY OF f�t�
The foregoing instrument was acknowledged before me this day of , 20_1(,
by who is'personally known to me, or who has
produced as identification.
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Si nature of Notary Type JrPrint Name o Not u) '# s 0,
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Title: Notary Public Commission Number 3oN epi�o�� to ales
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