HomeMy WebLinkAboutRevisions; Owner Builder Electrical Affidavit.OFFICE USE ONLY: L
DATE FILED: lam' �G
REVISION FEE: �W
PERMIT NUMBER:
RECEIPT NO.:
ST. LUCIE COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION FOR BUILDING PERMIT RE`'ISIONS
PROJECT INFOR:NIATION
1. LOCATION!SITE
ADDRESS:
2. DETAILED DESCRIPT NS OF PROJECT
REVISIONS: JIner -
3.
CONTRACTOR INFORMATION
ST. OF FL REG./CERT#
BUSINESS NAME: .
Qualifiers Name:
.ADDRESS:
CITY:
PHONE (DAYTIME):
a. ARCHIT/ENGINEE
N A_NIE:
-ADDRESS:
- CITY:
- PHONE (DAYTIME):
ST. LUCIE COUNTY CERT.»
STATE:
FAX #
ZIP
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OFFICE USE ONLY:
DATE FILED: !e /5e-1 �77
REVISION FEE: -fS-O
PERMIT NUMBER: a
RECEIPT NO.:
ST. LUCIE COUNTY
DEPARTMENT OF COMiMUNITY DEVELOPMENT
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652-
561-462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION!SITE
ADDRESS: _JaC-jc -.-nn
2. DETAILED DESCRIPTljpNS OF PROJECT
REVISIONS: � �i,l 2r .- �✓ /czL�✓ cif
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3.
CONTRACTOR INFORMATION:
ST. OF FL REG./CERT#
BUSI.NESS \.kNIE:
Qualiriers.Name:
ADDRESS:
CITY:
PHONE (DAYTIME):
4. ARCH IT/EL GINEE
NAME:
ADDRESS:
CITY:
PHONE (DAYTI.NIE):
ST. LUCIE COUNTY CERT.!!
STATE: ZIP: _
FAX #
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'M 71 45t-w:
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, Fl. 34982
Phone: (772) 462-1553 Fax: (772) 462-2522
hftp://stfucleco.gov/ce
Date: 16 October 2007
Job Address: 930 JACKSON WAY
Received By: gersteml
Paid With: CK
Building
Receipt
Paid By: FLOYD A GRIGSBY _ Sign:
Receipt #:
0000058189
ermit Number:
SLC- 0702-0269
Amount:
$50.00
�redit Card Number:
Check Number:
2830
St. Lucie County
c23Virginia AvenM
00
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Building '& Zoning
Ft. Pierce, FL 34982-5652
462-1553
ONW ER/BUILDER AFFIDAVIT -ELECTRICAL CONTRACTING
DISCLOSURE STATEMENT
F.S. 489.503 (6) EXEMPTIONS
State law requires electrical contracting to be done by licensed electrical 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 electrical
contractor. even though you do not have a license. You may install electrical wiring for a farm outbuilding or a single-family or
duplex residence. You may install electrical wiring in a commercial building the aggregate construction costs of which are
under $25,000. The home or building must be for your own use and occupancy. It may not be built for sale or lease. If you
sell or lease more than one building you have wired yourself within .I year after the construction is complete, the law will
presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as
your electrical contractor. Your construction shall be done according to builcmg codes and zoning regulations. It is your
responsibility to make sure that people employed by you have licenses requkaa by state law and by county or municipal
licensing ordinances. Failure to do so may result in a liability for you!.
To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit
application.
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 Community
Development Director to the Florida State Department ofProfessional Regulation.- Signed and acknowledged on
this day.of c>k,4cP ,,d_, 20.c>*7.
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iwwu UII�DER SIGNAT
STATE OFF '0
COUNTY OFF
-The foregoin ins rument was acknowledged before me this N 0 - day of OCl , 2; 1, by
3 S b who is personally known to me, or who has produced
0 r entificatio
iQ (Seal)
SiGNA91AVOXROTARY Type or Print Name of Notary
Title: Notary Public Commission Nu
�Y ey LORIE A. GERSTEMEIER'
r: ,r MY COMMISSION # DLD'
EXPIRES: February St. Lucie County Owner Builder Affidavit -Electrical Contracting 9onded 711m Nol3ry PubiH
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