HomeMy WebLinkAboutBuilding Permit Pkg All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1 �QU f ���
Date: c_k �Q�/ Permit Number:
0 Llo 1.UCE:�=�\ RECEIVED
c ? Building Permit Application OCT 0 7 2020
Planning and Development Services St.Lucie unty
Building and Code Regulation Division Commercial Residential Pe Ong
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
2
Address: '�-
Property Tax ID#:4_8 L4n— Lot No.
Site Plan Name: Block No.
Project Name: / {�
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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:
f
Cost of Construction: $,M Utilities: _Sewer _Septic, Building Height:
K � 'i .�3
Name 'Name;
Address: .Company;.
City: , .. ., .. . ..$_t_ate ;,.",•Address:....,..,..f
Zip Code: 3�r18 Fax: City: State:
Phone No. — — E- Zip Code: Fax:
c
Mail: ap Phone No
e
Fill in fee simple Title Holder on next 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.
� s.al;� i_u -Y e"t .� - •. '�'__xt � fir{'•-- "z`` ,��,r •mac - �. - � r�
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable -
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
y 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure:"Please consult with your Homeowners 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,iri 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
WANING 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 recorded in the public records of St.
Luc e\County and posted on the jobsite,;before the first inspectio f you intend to obtain financing, consult
wit ender or an attorney-before commencing wor r`•r'ecor our-Notice of'Com�rnencement. '
Signa r of Own as gent for Owner
S E OF FLORI
COUNTY OF
Sworn to(or affirmed) an\s scribed before of Physical Presence or Online Notarization
this 0�day of 20 y
Name of pers g statemen .
Personally Known Produced Id e�—ication
Type of Identification Pro ced
(Si re of No ry Public-State of Florida)
;:...r�'h\. ULA A.MASCARA Commission o. (Seal) ; C
o ission#GG 347758
•s vzY: Expire ugust 31,2023
and d Thr rn Fain Insuranc
e 800-3 05-70 9r R Y 1.
VIEWS,, _ - FRONT ZONING SUPERVISOR PL'ANS\ GETATION, SEATURTLE MANGROVE
1'
'COUNTER REVIEW REVIEW REVIEW 'REVIEW _ REVIEW REVIEW
DATE \\
RECEIVED y
DATE
COMPLETED
Rev 20 2
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 conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure, Please consult with your Homeowners 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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signat of Owner Less a/Contractor as Agent for Owner
ST OF FLORIDA
COUNTY OF s� •L,UCIE,
Swo to(or affir d�a d subscribed bef r%me of Physical Presence or Online Notarization
this T day of 20, y Name of person making statement.
Personally Known OR Pro uce d tification
Type of Ide tification P. uced
(Signature of Notary Public-State of FI
yp�i/� KAREN S. NIELSEN
SPR �9 i
Commission No. (Sea �_° ;state of Florida-Notary Public
-' •= Commission #GG 207484
My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
O Planning&Development Services Department
o o Building&Code Regulations
2300 Virginia Avenue
Fort Pierce,Florida 34982 RECEIVED
(772)462-1553
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT O C T ® 7 201-1
F.S.489.103(7)EXEMPTIONS ST. Lucie County, Permitting
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 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.
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-if
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.
Initial Here.J�
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 Hereif
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` alit
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 violLheFlorida
the terms of the owner/builder exemption shall e reported by the•Building and Zo in
Dep t St epartment of Professional Regul tion. igned and ac� ledged on this
day ofof 20 � r* ✓1^�.4, n
rBui VrS gnature
STATE OF FLORTAA
COUNTY OF
The f regomg.ns'trament was aqk5owledged before me this day of Q ,20
by who is personally known to me,or who has
produced as identification.
1
Signatulre of Notary Type or Print Name of Notary (Seal)
Title:Notary Public Co m' s'
KAREN S. NIELSEN
florState o Florida-Notary Pub li c.
i # G2Commssion G 207484
MyComisi Expires
20`
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
COUNTYBuilding& Code Regulations Division
2300 VIRGINIA AVENUE RECEIVED
FORT PIERCE,FL 34982-5652
(772)462-1553 OCT 0 7 2020
Lucia
FILLED LAND AFFIDAVIT $t'PerrmittingntY
I,the undersigned, am the owner of the following described property,
8 qn q -s1_3- 11 -1,1t) -_,3, -vt r A-M
(Parcel Id /Legal description/Address)
for which I have applied to St. Lucie County fora Final Dev opment Permit. In
accepting this Final Development Permit, BP Number Tracknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code,I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Oa-pld
Property Owner Name(Please t)
qpoeorowd�rlr Date
STATE OF FLORIDA,COUNTY OF .LVA..0
ACKN!i LEDD—G{-ED BBEEFO 'M.E THIS. �� DAY OF LI(� 20
BY_ (( Il. 1 V, �lX�l� WHO IS PERSONALLY KNOWN TOME OR WHO HAS
aRDCED /� /� ATYPE
AS IDENTIFICATION.
SIGNATUREOF NOTARY PUBLIC � ORIPR�TARP
COMMISSION NUMBER
:��Pl�gq•.- PAULA A.MASCQ W
Commission#GG 347758
ExpiresAugust31,2023
'!!,!; Bonded Thru Troy Fain Insurance 800-385.7019
SLCPDSD Revised 04/11/2011
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RECEIVED _
OCT. 0 7 2020
p�/ UCI6 County-.
_PerMItflrig