HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a o - 05,
Date: V�r 21-�/'`2d Z2 Permit Number: V
9U LU-0111-: ` GgIVED
Building Permit Application
St.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: CCti
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Address: ld' N �b �' `3�rC T \ ►�rGe T L . '�>49L1 I
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
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: $ Utilities: —Sewer —Septic Building Height:
Name
03 w-,c" Name:
Address: /) - r I Company:
City: �-d (E ITCH State: I Address:
Zip Code: 'c{`A LA Fax: I City: State:
Phone No. "11`Z - D I " } Zip Code: Fax:
E-Mail: 1N I I► Ci✓v--,5- 9ma- ne No
Fill in fee simple Title Holder on next page {if different E-Mail from the Owner listed above) I State or County License
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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.
Sir.IUME
Q Planning&Development Services Department
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.
Initial Here. C.
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.
Initial Here.
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. C c..w
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. C w
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 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. C 4/
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. C .C/
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 Zoning
Department tp the Florida State Department of Professional Regulation. Signed c owledged on this
day of _ of 20�Z
Owner/Buil tgnature
STATE OF FLORIDA
COUNTY OF Sk L J C'.L
The foregoing instrument was acknowledged before me this�day of 20 Z2
by who is personally known to me,or who has
produced �(� as identification.
Signs ure of Notary Type or Print Name of Notary (Seal)
Title:Notary Public Commission Number
. RY PVC HEATHER BURFORD
State of Florida-Notary°��= Notary Public
commission #GG 183217
+, a;Z My commission Expires
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FOF February 06, 2022