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Home My WebLink AboutBuilding Permit Package All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED �'jj 1 Date: '�"^'�� ' � PermitNumber:;�V�_ 9 .LUCE RECEIVED Building Permit Application JUL 0 7 2021 Planning and Development Services St. l1Ge unty t".rnd ino 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: y;tea L d y. y,. •--3��1..4.'F r "RO /E( [I=1T� Ztf y : � . v = Address-_5� db b Property Tax ID#: 2-' b 1 l' ) �,��b� - Lot No. Site Plan Name: Block No. Project Name: i -.-� T - New Electrical Meter Second Electrical.Meter (Affidavit required) ___.+', Additional work to be performed under this permit-check all that apply: _Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond Electric lumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Constructions: Sq. Ft. of First Floor: Cost of Construction: $ 5 �I a Utilitie —Sewer —Septic Building Height: Name Name: Address: Company: City: St ' Address: Zip Cod F x. City: State: Phone N LLC-� Zip Code: Fax: E-Ma� ��h tt Phone No Fill in fee simple Title HoldeP4 &0929��tliffe" -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. `?t*+,'i'� u[ a • a rt _A*.� .sr.,:;�..'�x4."?�:a. _ ,�.m�w IR- 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 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 paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie C my and posted on the jobsite before the first inspection. If you intend to obtain financing, consult w en er or an a orn ore commencing work or recording our Notice of Commencement. ignature of Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA ��• ��, COUNTY OF / Sworn to(or affir ed)and subscribed before me of 1/ Physical Presence or Online Notarization this day of 20�;Q by �_ l�'1C�.��n ��f111✓ Name of per n making statement. Personally Known OR Prod�W.-Qd Id tification Type of Identifica)'on Prod ced (Signature of Notar Public-State of Florida) Commission No. I KAREN S. NIELSEN pjP BG i ;2 ,State of Florida-Notary Public _• * commission # GG 207484 "s� c c June 12, 20 2 REVIEWS SOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 21 O Planning&Development Services Department • • __ _ Building&Code Regulations REh�I� 2300 Virginia Avenue Fort Pierce,Florida34982 JUL 0 7 2021 (772)462-1553 COUIR OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT St.PerniminZ W 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 comp te, 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 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 2' ivil 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 this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable for the cost,,*he license. Initial Here. I understand that if any person that is unlicensed and uninsured gets injured on my construction project-t ey maybe entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical cost, w 'ch 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 bui ' g 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 Dep erlt to the Florida State Department of Professional Regulation. Signed and ac owledged on this da�L, of 20g/. '41 / . er er t STATE OF FLORIDA COUNTY OF - The fpregoing in rrent w' c—a dged before me this day of ,20 QJ by ,.�O who is personally known to me,or who has produced as identification. Signature o ary Type or Print Name.of Notary (Seal) Title:Notary Public Commission Number KAREN S. NIELSEN :State of Florida-Notary Public =* — Commission # GG 207484 cy da r\Fj My Commission Expires June 12, 2022 STLUCI -( DEP ; ;�� w, - ST LUC1:F,,;>C,QU:NTY WATER & SEWER DISTRICT (SLCU) 2300 VIRGINA AVE p�=� FORT PIERCE,FL34982 ,- NEW CUSTOMER APPLICATION St. Njivi2021 12:23:31 ±: �— RECEIVED 07-( CREDIT CARD MC SALE � JUL o 7 2021 BROU XXXXXXXXXXXX2793 t� St.Lucie County FLRI Card Mastercard NAME C) . Chip Card: � 349E A000000O041010 Amou Q: 13 ACCT.# --� SEQ d: Amou Gatch k: 161 L, INVOICE 13 SERVICE ADDRESS _) ) (n i ►'1 ~ Chan Ppp royal Code: 05247P Than Entry I Method: Chip Read Mode: Issuer _ User SUBDIVISION i _ LOT BLOCK SALE AMOUNT $521-25 "INSTAL BILLING ADDRESS _ CUSTOMER COPY �...` EMAIL.ADDRESS: XTER :. �� r " rC PHONE# �. �1�C? �l T! MOVE IN/CLOSING DATE--Q 7)011.�0��' 1 CFC/SEWER,` GUAR. REV. This application hereby requests and authorizes the Utility to render water and/or sewage disposal services to the premises described above in,accordance-with,the Utilities present or future rates;.rules and LATERAL regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility promptly for TOTAL such services in accordance with the established rules and regulations. CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT APPLICANT'S PROPERTY,REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE. CUSTOMER SIGNATURE '% SOCIAL SEC/FED ID NAME OF SPOUSE -�o �i'��'- -'� �✓`�t�� `' SPOUSE SOCIAL USE • CASH OFFICECI €CIC#L �! DATE RECEIVED I RECEIVED BY