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Home My WebLink AboutBUILDING PERMIT APPLICATION All APPLI BLE INFO MUST BECOMPLETED FOR APPLICATION TO BE ACCEPTED QQ Date: Permit Number: 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: Address:3l�-2 Property Tax ID#:_ �,7 — �� V�" Lot No. Site Plan Name: Block No. Project Name: LP Dl A WSW x 4 ` A `�l O � N'cw Electri Oft!eterecond Electrical Meter fidavit required) ,I _ 16101 i a s - Additional work to be performed under this permit—check all.that apply:. _Mechanical Gas Tank„ Gas Piping —Shutters _Windows/Doors _Pond ss , _Electric!.'.,- 'Plum, 1bg :;Sprinklers —Generator _Roof Pitch Total Sq'. Ft of Construcfion _ Sq. Ft. of First Floor: Cost of;Construction' C^�U�, O:� Utilities: _Sewer _Septic Building Height: Name 6 Name: Address: oo Company: City: t12'r, C-)P-- StateTo' . Address: Zip Code: (42 Fax: City: State: Phone No. Z' 2,!5-- 5c & Zip Code: Fax: E-Mail: e. C) d Loa 1,kej '2D20F Phone No Fill in fee simple Title Holder on next page ( if di ent E-Mail from the Owner listed above) e State or County License Ali 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. i DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _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 an 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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult wjlb lender or an rney before commencing work or recording our Notice of Commencement. Sig%Lu,70f Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF .ae Sworn t or affir ed) and subscribed before me of Physical Presence or Online Notarization thi day of 20V by Name of p s n making statement. Nc G 60imm Personally Known OR Produced Identification 2Type o Identification Produced L tera (Sig6tJreTof Notary Public-State o lorida ) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5 2 21 , o L��CC ..,� 1 p .r N Planning&Development Services Department L' �,v o Building&Code Regulations 2300 Virginia Avenue Fort Pierce,Florida 34M (772)462-1553 OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT F.S.489.103(7)EXEMPTIONS licensed contractors. You have applied for permit under an State law requires construction to be done by 1 pp 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 H ce6u 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 exemp ' n. 1 Initial e . �f' You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed t form the work being done. Your construction must comply with all applicable laws, ordinances, buildi b cod and zoning regulations. Initial ere. V� I understand that the building official and inspectors are not there to design or give advice on how et the minimum code. Initial re. (93LKJ I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handle in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. l Initial He W 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 the license. Initial Her I understand that if any person that is unlicensed and uninsured gets injured on my construction project2wai entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medica could include loss of wages during recovery from their injury. Initial HTo 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 I further understand that any violation of the terms of the owner/builder exemption shal reported by e B cling and Zoning+h Departme t to the lorida State Department of Professional Reg u ion. S' ed and ac o led ed on this day of T of 20V. O n wilder Signature STATE OF FLORID COUNTY OF The foregoing instrument was acknowledged before me this day of 2 , by who is personally known to me,or who has �$iog duc d, as identification. A�ature Notary Type4o Prime nit N\me of Not ;+1?+ s � �LARWMWGRAM-RMM5060 Title:Notary Public Commission Number g; 0. p1Pl ;ptbet20,2022 €,littei�� Bonded110K0WyPv*UWeMitero MIN. SETBACK REQ. FILE FRONT SIDES COPY CNR SIDES bl REAR ol Z NG. TECH. {� J rc�rF - 4 T v" Page 1 of 1 .r Al s� r https://www.paslc.org/ImageSketches/image/11/11359_11983_1.jpg 8/25/2021