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Home My WebLink AboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /Inn Date: Permit Number: V ' ov.IL LC o r s g = ° Building Permit Application Planning and Development Services 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: 'k �`"x�."T--G 4' ' "+ �•e:_=3'4 'ice i Address: - SO �� '1 ��v. V\,z. % V IL (Property Tax ID#: c�L� ��' WrVin • 000J') Lot No. Site Plan Name: Block No. (Project Name: '[�(: 'cr ��,/-, �p ,. - I ��IEQ i�or YYIl 315eY + x. -•-„.. "-sx 4r .,... ..f,'�:. '�5r P x,E w .7 ..n` a�, f` -�. ,:," _ '"P.r''• L ``. '`_ �A"u�) \,o New Electrical Meter Second Electrical Meter (Affidavit required) a 9 a}�{[ Tim � f9 e 's" t '�`�` p�rte '� E` ��nA.�' * ate.'^ r��#- GI1. ,.�16i1''► �� ..ar,-?_ 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: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: 3UY `"� _' i � -ry'4 , 7�t` } 4. '� C .3l�1Tf ?ft , £ iP" ."' .RYA h•;r p`' � Name: Address: 5�0 C V Company: Address: Zip Code:214MQ _ Fax: City: State: Phone No.S(Gk-S1CX�-I�,_23LA Zip Code: Fax: E-Mail: G,t`�o4 Q_QtX1 Phone No Fill in fee simple Title Holder on nex 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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. O 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 and by coury or municipal licensing ordinances. Initial Here.IL__ If you sell or lease a building you have built or improved within one year after construction is complete, t 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 licensed to erform the work being done. Your construction must comply with all applicable laws, ordinances, building cod d zoning regulations. Initial Her . I understand that the building official and inspectors are not there to design or give advice on how to me t e 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' it court with the advice of an attorney. This department will not mitigate any contract disputes. Initial Her handled 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 ' license. Initial Here. I understand that if any person that is unlicensed and uninsured gets injured on my construction project-they ay be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical cost, w h 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 s"eignhure g and Z ng Dep e to the Florida S t Department of Professional Regulaton this day of of 2 STATE OF FLO COUNTY OF regoing ins ent was acknowledged before me this day of ,20_,�] , by who is personally known me,or who has oduced dentification 0 L4-%ANNAINGR,q(y.RAl1MIN Si a e of Notary Type or Print Name o Notary (W§PW)W 831pN#GG G 275060 Title:Notary Public Commission Number '•tcRo;;r kIRRENN0bIrS.DecembP-r20,2022 Public tindery era 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. ,n consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work 1n 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 N Aice of Commencement must be recorded in the public records of St. Lucie County aJapttorn(�' osted on the job e before the first inspection. If you intend to obtain financing, consult with Se rb ore ommencin work or recording our Notice of Commencement. 1 I S' t if�JKe / ess ntractor as Agent for Owner STAT OF FLORIDA COUNTY OF � SworAo(or affir d)an6 subscribed befo�rg me of �Physical Presence or Online Notarization this day of 20:L1 by ^A Name of person making sta ment. i Personally Known OR Produced Identification Type o entification Produced (SiA v Pi thIi6;"�_c)TFJn&?ha) ,_ LASHAHNAMRAM-IMMING Co ri,r' r� #pCCOAMIII6$0MGG275060(S aI) A, Ma EXPIRES:December 20,2022 Bonded Tttlu Ndw Public Undenxdters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2 I I ST L=ECOUNTY WATER WSEWER DISTRICT (Smu)-z-, KEW CUSTOMER APPLICATION i:A WATER COMM SEWER �RES NAME METER SZ. _MJF ACC IT.A. - � � �'�� °`,�, iRR OP L SECURITY DEP SERVICE ADDRESS S S c3c� C+tCVR, 2)42:=-- -SERVICE FEE -SAME DAY FEE � Su.0DIVI.Slon N �q a 1 ;Q kkz e4 Fps LOT OVERTIME FEE METER,INS'TAL SILLIN.GAWRESS � 4'1' Ayvc- .3&3. t4ryo ?C-acrl.rfG FPVA.CFC Mcat t. -~ ? '- MOVE INICLOSING.DATE CFc/SEWER GUAR.REV. This application hereby requests and aufhorizes the Utility to reader water and/'or sewage disposal senricesto the premises described above in accordance wlib the Utilities present or f4ture raW,rules and LATERAL regulations,which by reference are made apart of this contract.Applicaritagrees to pay utility promptly for -r- TOTAL such services in accordance with the.establishedf rulbs and regulations, CUSTOMERS DEPOSITS ARE.I40 NEGOTIABLE ORTRANSi= LE APPLICANT A.GREF9'Cli-UT rAPPLIC"r W11,L BEGIN PAYING BASE FACWTV C€ARGHS �.�� `i±-M. `Y .. . APPMD.TOR ON TM DAY 'PUE WATER M-C-Tib R OR, OTHER �XJTIUW SERVICE CONNWI nON 1,S INSTALLED AT I APyL1CA1V T' :PRC I' ]IL'L Y,3 G' T.irSS OF WIMKAPPLICANT5TA.11TS'Yi'filELT2]IVG T IV1vG 2 IE3 HC' . CUSTOME11,516NATLIK. a $0QA.LS%C/F -ID NAME';OF SPOUSE. f/��'r"!c�+ -4 tee~ SPOUSE SOCIAL_ � -77 i OFFICE 11SE OKP 4. DATA RECEIVED ` CASH �dl # RIECEf1lEQ RY 4. --