HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� �� Permit Number: I
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° L L' `` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Resideiil g..�ry
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT L..{O_CATION:: /� � ��},L-7
Address: N • 37�" �S FtAef(-Q Iq sJ`4 77 I
Property Tax ID#: — ��- f '"5 Lot No.
Site Plan Name: ��/ Block No.
Project Name: V ��j lmrtI1C o
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 ),I P Pitch
Total Sq. Ft of Construction: KI Sq. Ft. of First Floor: I
Cost of Construction: $ �J Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name v Name:
Address: gap N. ,31!?' 1-� Company:
�City: PII(X4L; State:= Address:
Zip Code:3LH47 Fax: City: State:
Phone No. Ma-6-N E- Zip Code: Fax:
Mail: Phone No
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
/&rv\Q Lo zap d CL((k 0 e
nature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORID � LIIC.�
COUNTY OF
Swor to(or affirm and subscribed before me of /Physical Presence or Online Notarization
this ed day of 20 1-ty
Name of person making statement.
Personally Known OR Produced Iden 'fic tion
Type of Identification Produced
(Signature of Notary Public-Stall ofFlorida)
Commission No. (Seal) ZLOZ '9U Ajenjgoe W;0,,,,
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LlZ£8l 50 N uo!ssiwwOO s`s :oilgnd tiieioN-spuoi� }o
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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NOTICE OF COMMENCEMENT
Permit No. 2111-0392 Property Tax ID No. 2408-242-0010-000-5
State of Florida,County of St.Lucie
The Undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
Legal Description of property and address if available
8 35 40 S 75 FT OF W 137 FT OF S546 FT OF N 726 FT OF SE 1/4 OF NW 1/4 (43-1) (0.24 AC) (OR 1654-938)
General description of improvements RE-ROOFING
m�FD;
Ownertlessee AMANDO CHAVEZ o M 2_
202 N 37TH STREET FORT PIERCE FL 34947 o g m
Address Z A N o m
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Interest in property: �,�+N 0 3
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Fee Simple Title holder(if other than owner) $M N-1 m
mN <M
0
Address w; F
OWNER BUILDER Lh X
Contractor Phone# w
0
m
Address Fax# g m
Surety Phone# M
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Address Fax# i
0
Amount of Bond c°
M
Lender Phone#
Address Fax#
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served a;
by Section 713.13(a)7.,Florida Statues:
Name Phone#
Address Fax#
In addition to himself,owner designates of
Phone# Fax#
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Expiration date of notice of
commencement is one year from the date of recording unless a different date is specified. WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CH.713.13,F.S.,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCMENT.
Owner/Lessee,or Owner's or Lessee's Authorized Officer/Director/Partner/Manager/Signature
OWNER
Signatory's Title/Office
State of Florida,County of ST LUCIE
Acknowledged before me this 18TH day of NOVEMBER 20 21 ,by AMANDO CHAVEZ
16o is personally known tome or who has produced PERSONALLY KNOWN as identification.
0 CELERINA ALVAREZ
Signature of Notary Type or Print Name of Notary ��pv C&OA ALVAREZ
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GG978235 �'�"'••� Canmis�on1100978235
Title: Notary Public Commission Number „ Fjcplre$August14,2024
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O Planning&Development Services Department
Q e o 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 county
or municipal licensing ordinances.
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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.
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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.
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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.
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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.
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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 Here.
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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.
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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 shall be reported by the Building and Zoni
Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20,_.
fi( .�MUhC�LO2d'Kc5 0c cx(leZ
wnerBuilder Signature
STATE OF FLORIDA
COUNTY OF 4,54— Lx r Ar
The foregoing instrument was acknowledged before me this ZC day of ,20_�4 ,
by who is personally known to me,or who has
produced as identification.
Signature of NotaryType or Print Name of No♦ ,,, 90 Aienige� "-'--"
a J S 6WUOIS e i W W 0'�/�iN •,``ii11���i�.
Title:Notary Public Commission Number [lL£8t 99# UolselwU,o
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