HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMP
VIIETR APPLICATION TO BE ACCEPTED 1
Date: I I b 1�� �EuC Permit Number:� 1��
NUV 0 8 2021
9-U.LUSQ St.Lucie County
D I I Permitting
LF '. 3 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
_W _ -
Address: —1 y U _ _
Property Tax ID#: 3 ( 0._ 0 100190 _ Lot No.
Site Plan Name: Block No.
Project Name:
-�02KO �
MX �NXRN
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ItSTAI_C 55' GALVAN1Zf=p 5 'H ICmd CHAI'1'4 L1/\IK FENCE C,0Nr4ECTE
TO OrIE S' H i6iH 06(,ARt.E LATE CONtJECT - TO 30" GALu8tglZED
5, HIGH C FlAont L1 NK FFnlCE FtitCF. w1C( RLAN Ac1)n1C opE o f
CAR(?Ml- ort NoR
New Electrical Meter Second Electrical Meter (Affidavit required) Si Ot CP HOME.
`A'F' �4nu WIN
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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:
Cost of Construction: $ �{SC) 0o Utilities: —Sewer Septic Building Height:
4`
Name..-7 REMIAH C, I�lrn/C,S Name:
Address:q o9 CL)c. rgc47 AyElgUE I` - Company: _
City: P( R T ST Lu C I State:EL Address:
Zip Code: 3LJ 9S2 Fax: City: State:
Phone No. 9,S4 -(y$-703y Zip Code: Fax:
E-Mail:- � S�v 1233�q n'14 i l� - CUM Phone No_
Fill in fee simple Title Holder on next page ( if different E-Mail
i
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.
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 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 your Notice of Commencement.
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I '
Signa re of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA JJ
COUNTY OF S TL. x)a
Sworn to(or affirmed) and u s -Lbedbefore me of cal Presence or Online Notarization
this day of , 20�` (by
�h G�, YES
Name of person making statement.
r
Personally Known OR Produced Identification
Type of Identification Produced
I
(Signature of N AUGHN
,•�:�Yp , EL FIoNi a Notary Pub11C
Commission No. a�4 :State of '270079
missio fires
My commission Exp
peteber 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
O Planning& Development Services Department
DRUM= • Building&Code Regulations 444
2300 Virginia Avenue /(� o*/�
Fort Pierce,Florida 34982 N0L B
(772)462-1553 4 08
OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT p@ c�eg ZOjI
F.S.489.103(7)EXEMPTIONS �i1111V,n41
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 comple , th
presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. ' /
Initial Here. ►G ?�
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.
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 Her IC
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.
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 Herin--�
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 Zonin
Department to t^heF lorida StaLe Department of Professional Regulation. Signed and acknowledged on this
day of K) W of 20 d,.(
eiBuilder Signature
STATE OF FLORIDA
COUNTY OF $ { C—i t c
The foregoing instrument was acknowledged before me this Q day of �T _,20_
by hc'1t&+) &V N who is personally known to me,or who has
prod d V as identi
P,,, E�L E----_
�t, ^ n V - N VAUGHN
lx,' 1 'r UState of Florida-Notary Public
Signature of Not Type or Print Name to - Mr" '"' ' #G G 270079
Title:Notary Public Commission Numb -1 11 yOctobe S22 on Expires