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Home My WebLink AboutBuilding Permit - Owner Affidavit - NOCAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce F134982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding PERMIT APPLICATION FOR: I PROPOSED IMPROVEMENT LOCATION: Address: -?a 1=Ui11).AZ lf- VwlhI r1EK%-r_- r'� r c Property Tax ID q: )'y z Site Plan Name: I-Akag g.�S1�QLIVG% Project Name: DETAILED DESCRIPTION OF WORK: ,81115I71D )IFS ) DF X.iL:){Al Jlv/✓I/ -2-f__ i-ram New Electrical Meter 1/1_1�— Second Electrical Meter i CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: (Affidavit required) Lot No. Block No. _ Gas Tank —Gas Piping _ Shutters t/ Windows/Doors _ Pond _Mechanical _Electric ,�flumbing _Sprinklers _Generator Roof 2 Pitch Total Sq. Ft of Construction: Cost of Construction: $ 7S OC-' Sq. Ft. of First Floor: _ Utilities: 'Sewer Septic Building Height: )z ty OWNER/LESSEE: CONTRACTOR: Name S6ci7 UA —A)3 Name: Address:("yrCl' cj Company: City: Si , UGr1/CST State: L Zip Code: 7�� sL 9 Fax: Phone No. -i-7 2, - 332 - 6'7 O E- Address: City: State: Zip Code: Fax: Phone No Mail:STA K A3 p CCJ^Cw:"r7 7V rr Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail 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. Z SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Name: 2iNlot Applicable 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 rantingg a permit will authorize the permit holder to build the subject structure which conflicts with any applicable HomeownersgAssociation 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 Ipndpr nr an ettornpv hpfore commencing work or recordine vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORID a, p COUNTY OF `�i� Swor (or affirmed and subscribed before me of Physical Presence or _ Online Notarization �20,L[ this =day of by Sew- -J 4 " Name of person making statement. Personally Known OR Prod ced Idnentification Typ o Identification Pr e /.(' C- 11 50, ('not a of otary Public- to of Florida) �I �4�'A+�VB� Cynthia L. Mathis Commission No. U (Seal) State of Florida �3�My Commission Expires 04/07/2024 OFM1op Commission No. GG 976759 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5/20/21 3 97o WCUE O U Planning & Development Services Department 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. Initial Here. 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..,� 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. d/ 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 Rf 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 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 to the Florida State Department of Professional Regulation. S1 ed and acknowledged on this day of Dc _of20Z1 wner/Buil er ignature STATE OF FLORID COUNTY OF - �p The foregoin i ment as cknowledged before me this e f4ay of�XLd�,� by a D tt Vct /C& A who is personally known to me, or who has prodtrcu //� /� as identification. l :V /ll T`i1 R _ L V °4 Cynthia L Mathis namr o ota T e or riot Name of No 4 0�: ! State of Florida ry YP /�' 6 7, rip My�nission Expires OM7/2024 Tit e. ary Public Commission Number ! orH Commission No. t3Gf176759 7� #wKA, of Permit No. No. State of Florida, County of St. Lucie NOTICE OF COMMENCEMENT /cJ Property Tax ID No. J Z8 - 7-0 3 — !LA ?—Cja 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 XX 1= i»,.r i it.J AVE F!�Jp'777 211PIPGC-,o Fe :? — — /— `+.- Ilt„e,...., Q? )e ica PAS Sy ' }TjA General description of improvements$E,_�a�, L l�omP Owner/lessee Address "lay{ AB!!! lA S7 S7' 7"*ACAtI Interest in property: 04U Fee Simple Title holder (if other than owner) Address Contractor i u# M as « n1>'� Phone # Fax # Address Phone # Surety Fax # Address Amount of Bond Phone # Lender Fax # Address Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (a) 7., Florida Statues: p Name Se�T TAI<A Phone# CT S7— TFtiLC �� 3Z2= Fax# Address'3]4$j GrY!!!i` In addition to himself, owner designates Af�"1 26 lS A 9 of Phone# op1.1-2 1 1-)'6, `ka� 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 NTEND 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 Ofticer/Director/Partner/Managev asgnamre Signatory's Title/Omce State of Florida, County ofH— Acknowledged before me this day of — 20 3/ , by ZR;W�7 oduced r"L i' �< C as identification. /ltrVY+t A_ Fla Type o Print Name of Notary p..•` e�e�Mathis 0 Stateto�Florlda Title: Notary Public Commission Number fT 7k 7- 6 ;,i� Commission E:piros D4/07/2024 oe r� Commission No. GG 976759 t4