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Home My WebLink About Building Permit Application All APPLICABLE IM01MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: RF 6 m ., Permit Number. ( �� uL_U 4" LULI 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 CBDG Funding PERMIT APPLICATION FOR: 4y f� ms.-� f+ 5 �'r" $ s."' ,� PR£ PaS € 1�/fROIE ILfl �41'if y, x xNIN �� Y f` p � Address: 3 "f J� /f U` c� Y _1�_/--7 Property Tax ID#: `�f 7wl- b 001 cro(-_ 1 / Lot No. Site Plan Name: ( Block No. Project Name: QX 0.Q2j } DCR PTiO'Ry,� �1t1rfiC3 t}y d s 7 •9.1'` ';' ., ..`t_ _:.... ._,u ..a ,.,.. �.�..:�nn __ ...... ......�<. .,. ._...ut:z ..�_r_„ ,. .. ._ .,.�_... .a ::§._.._o .., .a�7 Fn O.`C..Y L New Electrical Meter Second Electrical Meter (Affidavit required) .'y� ya'ieam ..' ,� ��,u�'ti.+�, a5' d ;€� ^'SEAM S A t � c ems.- y a s s x �, r�'e t,x� a .a£.d +ilk' .ffi § x C4NSTRilTIQ�1 IC3f�idTIQ � �y 9 Y;' �E �f � - 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: $ �c7� Utilities: —Sewer —Septic Building Height: QillR :ESSE Name W CL fY- Address: S )-dl ve r Company: City: roil^ A State: L. Address: �Vl� Zip Code: Fax: City: State: Phone o. Z- E- Zip Code: Fax: Mail: .L 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. 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. certify that no work o.r 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. Lucip County and posted on,the,jobsite before the first inspection. If you intend to obtain financing, consult wi lender o an attorney before commencing work or recording our Notice of Commencement. na r Contractor-or-Owner Builder as applicable STAT OF FLORIDA COUNTY OFC Swor (or affirmed) and subscribed before me of Physical Presence or Online Notarization this%day of D , 20_by Name of person making statement. Personally Known OR Produced Identification VL--� Type of Identifica 'on Produced till"(Signature �ublic- ;=o <,, tate o on a- Public Commission # GG 270079 Commissio P My Comrr(S�d�n Expires gow er 22, 2022� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev w llo La�l�HIE O \ - Planning&Development Services Department' " G'7 -,..w' s.� >' '_ 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 byi state law and by county or municipal licensing ordinances. Initial Her If a ell-or lease a building you have built or improved within one ear after construction is complete, then a o s y p Y gY P � - presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. ' Initial Here�k� 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. cn^ rV I I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled i, a civil court with the advice of an attorney. This department will not mitigate any contract disputes. " Initial Here. 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 Here Jo 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 e reported by the.Building and Zoning Departrr}en to the Florida State Department of Professional Regulation. oned and a knowledged on this day of of.20il. 0 r ilder Signature STATE OF FLORIDA COUNTY OF S� I,c _. < The.foregoing instrument was cknowledged bef `e this day of 20 , by S �� who is personally known • to me,or who has produced r. • , YP�� LEN VAUGHN ;=o`°. ° State of Florida-Notary Public _. •= Commission #GG 270079 Signature of Notary yp or Print Name of F-00A MY Commission,Mrs Title:Notary Public Commission Number 1