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Home My WebLink AboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q Date.jo Permit Number: -vl �L �� g Iio C.ME RECEIVED 2022 Building Permit Application JAN 3 1 � Planning and Development Services ;r.Lucie County Residential -)ermitting I Building and Code Regulation Division Commercial � 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: _�. Address: Y 113 6,eatr� Z. Ckb �6Ci �- Property Tax ID#: 3 L4 ft zEl f - 00 Lot No. Block No! Site Plan Name: Project Name: - t� New Electrical Meter Second Electrical Meter (Affidavit required) 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: $, -7 DD O Utilities: —Sewer —Septic Building Height: ;r -MIW Name 6 P 1 2D��1DL�� Name: W1 A S/m��Y Address: &M6 Company: City: S(_ State: Address: Zip Code: 3L[ Fax: City: Phone No. `29a- Q �D Zip Code: Fax: E-Mail: oumVY)0-1u-I do Q pA rt . CU4N 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. i 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 our Notice of Commencement. Gv Signature of Owner/Lessee/Con ractor as Agent for Owner STATE OF FLORIDA �l COUNTY OF. Swor tq(or affir ed) and subscribed befo[L��me of Physical Presence or Online Notarization this `day of 2196by P.:4,- F u (4wm V&r Name of person making statement. / "RV / �. �I Personally Known OR Produced-dentification ✓ ,osP �a�,.: l. NIELSEN Type of Identification Produced __ icia-Notary Public YP -' t Al GG 207484 1 �FOfF�°P' C:- r•sion Expires (Signature of Notary Public-State of Florida '' Commission No. (Seal) ;,PRY��a% KAREN S. NIELSEN �cState of Florida-Notary Public *= Commission # GG 207484 / OFF'V My Commission Expires June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE I COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5 Z 21 Planning&Development Services REC7D.Department p` o ;, o :,. Building& Code Regulations 2300 Virginia Avenue yy Fort Pierce,Florida 34982 JA N 3' g 2022 (772)462-1553 St.Luce Counbj OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT Permitting 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 constriction 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 Iffere. If you sell or lease a building you have built or improved within one year after construction is VcMplete, then a presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. Initiae. i 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. CU I understand that the building official and inspectors are not there to design or give advice on homeet the minimum-code. Initial Here. I understand that as an owner-builder that any contract disputes with sub-contractors and I must b hatted in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initiall-Ie I understand that if I compensate an person or company for work performed they are required to be lie ed in this P YP P Y P q 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 pro' 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 bV- apermit 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 owneribuilder exemption shall be reported by the Building and Zoning_ Departm nt to the Florida State Department of Professional Regulation. . igned and acknowledged on this -�-I— day of t of 20'ZTj n1 Owner/Builder Signature STATE OF FLOR�DA COUNTY OF��t LE The fo egoing tns ttgent was acknowle ed before me this 3 day of 20� by �V who is personally known to me,or who has produced as identification. Signature of Not Name of Notary (Seal) Title:Notar Pub c oP P�, KAREN S. 1i✓h t umber i ;zo State of Florida-Notary u SPB P _. += Commission # GG 207484 c 9, e� My Commission Expires June 12, 2022 i RECEIVED JAN 31 2022 � St_Lucie Courrty_ Permitting — �� aL VS L c( SZ