HomeMy WebLinkAboutPermit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date3_3_ZZ Permit Number:
910
o �
V ' 0 ti 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:
PROPOSED IMPROVEMENT LOCATION:
Address: ��n�'C> kirrm Ln/. �D�et Sj Lu�l�' . /�L
Property Tax ID#: 332 l- ,'5 61/. OU/l' -6J6__ l Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
�K Zkl r�=L4o ,P XS !z'r)LrZ �1 AIZ4 - -;�D GAL ILL,-,7/'ff- -6'L'_Q1-T
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: $ I% Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ni6� /L. /cz Name:
Addresses:/39//yev,,fA,Nr Lun4f/lJ1-sr�1 L2,, 394 Company:
City:/1-,e r sl- 1_Y1111'r, State:k1. Address:
Zip Code:3 419 6/o Fax: City: State:
Phone E- Zip Code: Fax:
Mail: �),gZAALI&4I - )-Jpr lAl 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.
U ;r!t
f; (ht�nshi
...._.�.____.__. ,.... ..._ ��_
I' �!
,
. C1', Vie')!TA")' IggN .li"Al11 ?�� '
I :
.f
•,
4�
4 r'
i!
+C!3r,"O t` ..y .D!�tiy� ,;�.✓i + •,#!,...r ;,.. }')G nh c � +ya ;j� �.��r:
'j .i.,'(�. 1i.�: �r.; ;r' _-n' ,„7 21:,i -" rJ i#: r�ujl ,} _ �.'.�(; c1C .�.. .:#-r„J ��.0 ,y*•! .,.r•.
A.
it i)', i , ,',,s;�`; �e,r:Gf2,Vv _ �:. �+' �"UCH. , `s+ ,• ., ?` _;ii(f ri•: � i__ �
t
,
.Jf, 'IiiG' '��'! !�'!Y!'i� ; i.n'i �7•al it
ti
• if, !
till {.,t :.l pp
l !'hiYl ] Ir'91�i3sb ff 1x9 9st�tq r, n,,) ribIc H.7 r3f(3 r . .h:, !J .ti il,a t
(evodoi Vf i2lL l9!f','147 yf! +7YD'% �
.6-fli+,pgy di 9r,3+mans mc: #o 1:10014 WaR01111 s. 9iom io Goes i quisv i! !
1r".'ri_;'3w1 n 169rJ s 4o eAiuIA(73aRO')4q 6�lYo(Yi�� ^',?A zi Jv fi to':&v t,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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.
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.
Ignat a of Co r ctor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF c L.rll.J
Sworn o(or affirmed)and subscribed befor1e me of ✓Physical Presence or Online Notarization
this N day of�/?Ze97LGW 20 Glay_
Name of person making statement.
Personally Known OR Produced Iclklltjfication
Type of Identification Produced [�(�
(Signature of Notary Public-State of Flo a)
Commission No. (Seal) HEATHER BURFORD
Notary Public-State of Florida
Commission * HH 218910
�, ^ = My Commission Expires
February 06, 2026
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21
:YVAa11l1O;) 30Ac73"tiOW' R33MIc7Vl3':.ls3Vlrile? 0
'
._._
:YY;AgNlo:)DMOH08 100JOH 3JT1T 3Jgp.�le 333
rl/a
nc,t..,)'IgoA :T]Vtllll i ROT'ZAATVO;6\A lWWO
G�.7!)f 17C�171�'''� f0 i'`!'.f2`!1 Jn'Yl t6ri1 a:?(15ft/i•�tl:f!.P :[ � l,�,'- ( 1 CGri t )C'?lr�J7Cf( '.Vf�f^rl!'j 9�L�G1:-'t ,�^lrs f'��'JJ t?;t,t tb•1 ti.�l..t,!' 1
YiOLji: f(ilr, C}t f,,l.i r•.,t1: ,J�.,_"A i',^il'•'I' r."3 lU h( ...i,L: flr;';'D3 3G65 C�.91 j.,i 1]?
-•.Gri:11 ii+id i fji •.S� 9-;t(Cr9!9i'Ot): .)ir'"EiC7
.:1(+3 R'i i,.?: i.11 �lf.iJ;?. 3tJU� t� ,�!E. z9rtO�;�fNt -lU� t,1 u,`.1 y, •,rlr.!� „-r��lg4E 9r�iy{iti 3"�i , .�. 7.� 7f l�
tt( ,1ffr It+t'i;•G fTlttOf.�l!"1 .r t 'rlf�11 !).`(ih�',Ut r(, t;glfl5 i "c tf,')
[j 'r?U GDG?f19�•t?JI .n;; :3f�1v(?i r11 292u 1+1n,'.G^}}E t)?11..,f :,f•'" .c,q, )h}�'7 ,Lli,w ,;`.i',i.� >:.i„t)'mm •fir,�:'.,t,
! zni s)iwl;;niyrq ni tluasi►rsm 7nnm-')ansrnn •)D 30 33iYOA !r blo.7yt+ 0' 91ulfst'TUOY-gMWU OT C 1I WAFRIAW
;c' }i fit'T:• f", SIjCt`1 ! "3ii1 fi. r ?1a10":"I hd ,?urn i') ndritl, h Vil`3 7Ca'ii< UJOY )I 27+i°1(Tt�j`,1{'yCmt l
—i r sni{ (r"i( C.i Wh51f, i!(,V 41 . lt�it -it!r.t+l 12.-M 9fIl elol -d n"Ji?dOj qdJ of) bole rl bnfs y,+m,:?.)
1 +v �t e , t r C�ZCrilJ-aoi i s(.,tr!U? 9')U,ail V`aii,fJi'•f, r,( '��r
AU1390'1 30 31 n'' �f
4 10 YTOUO:,l
_�3 .. _._ . II
bf,5li)77'tfll,,
1
r. 116:00pf of b',)'.Atniq Ri i
�� 1' ���y�. .}'� Fa�ri,�•.11 '� ;c:'J�J.._.. .----_..-'-'—.i;i� ': ,ic?!ff11T'r'i
�i ,oia t e�ie�� c• , . c 4 e
t H 1v. 3_'"'t;TP.32 ! i/iUTr Ic 'v ' ':i".!� r� )�,14 f 0-? i)i/' ! YY,CA" i'vv `il`a1�
I t .+ _ 'NiVvIp 3 ;fl a"� •:,i; Vr�Sv3A� A}(�i'j J
AC c�' 3
O f Planning&Development Services Department
p • • i_ - 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. _-t�
Initial Here. .1-�
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._J�L
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. 5(
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. 7::5('
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.-:5L
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 ZoniY�gQ
Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this 3
day of)1rlA41 A of 20 2_Z_ c
O er ilder Signature
STATE OF IF
—
COUNTY OF
The foregoing instrument was acknowledged before me this-3—day of ,20 ZT%
by who is personally known to me,or who has
produced ZZI Q ,+� as identification.
Alad./' /�1�=g� ICJ ww-
Signature of Notary �� Type or Print Name of Notary
Title:Notary Public Commission Number HEATHER B U R F O R D
Notary Public-State of Florida
Commission 8 HH 218910
My Commission Expires
February 06, 2026
S'Js,Tntti�cgyU >;',iri�l� tr4silltltll�"+•;fi 9,'�I11nnRt`! ,. �. -
rf,2,iiG1l)!;aS1!Jb2,7 .�;}stibilu8
9)1 ti�Jf fitni',J if�l fAJr
Pit!3 I,1T4!tlrf 1.10 1
TT ARTi r.i'i? AIV Iwo j".3!tQ 'f 1'll.tll l i/: I J(l.ltiJB',71'1�'ir+)
. :!G .,, ";n 4i _. r":rlrid: ♦;..±� ,-iU :(JJ.JC7�;if•) LJ (i:,[;,i 1;fI Urir?I' :J!i 2,) f:(',pj1!'Jr7ii<!J %r" rp7s f?bi .P4ir
!9 !(1fJLifi:QJ (Jar tU4/ 1:,. i1 .'I'J3r.'fwl IUU: i• ,,:1't)o :rtl rfi.L't)':. , .�tL'fI0t7(�rfl. `)rtT :f,, ;1(r'ei fr! i�,i?;•
)UY N ''ll!'1`! co I:ii1YJlflr,c, "t 1"' . . r3.zi l i',21-t 91G:�7TJ .1';)'[?I) ';biv l( I<wif lrt3( ." f FJJf: f- J'lL;i Lt)SJ ob JJ= :!,?;) '.
,. ,( jsrff i)•,7N !)i'R 'i•.'it t:'07 '±!2 ),;.:.iJ,i:`J' 'i""Gt•r;t!? T+;. { _ _Itrti(f-'Jt,n r. trilt;J 9r1"r!rytrtt 71J le,,:i;
.. 1`l±i•! b)r G) 'i _):!:� tlii,± -i�� J.!.. ')..L" !irf, tp.i , It. I±t.ti•1,;1 ,..'.:YNi['fJV:, r; ',i!,;-j("ii
YC!1(Jf :i:li71R e. IJif,% ,j (litV 10 Uiit;(I I')."yn,-v if(j
f•. 'i ,.,+;i"'i ,. .' �r.
;t. J l!: iiT
:J:')Jil ,)lJi!. I .�J .r l! )':�fi , t + liiiU'!f� 'it !-,1 sf;T -.)' '1':,` ' •..:r /,
i'117f.9-',Li! 'o!i'3,iG Ur I t>%t i-- f{ri." r'r:Vl !f?sa, i±'
'l'i.:itInitial
...'i-,_y :! icy-;i:")!' ,:)[. •:t" Tt ., f4'.,. I)' „i r: u! :�e!J ii yfll:.'/ b. .0: '/JII(:ti ,lff•.jG'ii", __'„ '+r' .!'.;. 1r 3f1 '11i1(1 w
`a" ! ,. 1J r!,:. .. ,_, '{:+. 91I;� r' ;:'7U OJ 7tj'�j i!�tS '3!L. .',nhj..•I..h il,'.' ,..f ��; , r!nfG�'„ _.. ,,.i '!,.,.'f_Ia •
if... i;, f,:Jli,. ,, ' `t'I !:±,!li ,,•f:.G.r.::)1.7:.'�.'):J-'�f�. 'Ji:'> i� f�,fi. a t',L •'f •7 !(!:. '-:f,i ,_ :I.rl"" i:.r�'' r+ ... �'f• ,
i:.wip' i' i..,l (,!,7 !r' 'A]'Al !'; :0i+ !!i.. ti,'d°
.J-+Jft 1!atll!t
!S .D>'(t70it 9fi 01 k7`,:'frt!(JI1 �7!i !%!�:1:i'l1Y''C:Jf' �' , (iJ.l Crlr!i'") rl+i''(_( f.. .;r` f•'lr
„f •,0,) 'it vol .l:;i:i{ I):i`. 'Ari fell. � _'l .rf,r,IJIaJ•- J7
, �`'tt' .')jLr!::J �!t!I:J)J-'J�ie'r', leer n.F I;'.!Y:'(11 77'J'i i19'!.rJ�'airill IJiU:,,.r t'J';•r':UU ,:! t.irit J.'w.7`;CI •lft6 !: j'ri'fl":+.r. .�4,;:.1 1
'•)rs il.'AiV; .,;i ikr, ;oi .Iri!,.i I.AA �i,i!•, i Jt 3,t)_ z 411".,; ; J t
I iJ�
•'a '1 if;atit .Y:1a i 'L`JS#i WWI; 111:,;,,::.T!�t JIJi:r.'t.:r_;J�', 'i,irl ft. +•-!_.. .
'I ,ttltr., J(! '..11:,fi0r'mw i,Jfrl .XWo Or.
!+; ;r, )' Ismr!i t.ol;.If Jtrl'Jtt(ifit,
i,. r•7:'�:.Jri;f ,.'':. I ;=i(li f)!I€: ..f7;_,i;tr .;r,.' !, ., „it ,. r r. 'r: --� ' I `i-i,'.I ,'r'3i- ;k.'� {
:'JfJ i:' .a(-•iJ! ;a.:F. rr,_ ,nr, JnfU
.J4\ .f�� Ji±'7fi )fti 'i"+,J• V, !!• 'Iril! ;J'�'1f.. -1A,IT ;U f v !~� .fl; Iri. 1!' 'fLCt;/1 �}
'lii? I)',_.�.7:•N?±T.!i:iR „i±' J!°=Jr'. i!'. +JH 6L'JH,I,'eAr'34 IU l;rf'.rrtlhi:rl`,'I lot I 'J1
�firt+ftr T'i tJi r,a'l.;'JrT r.f; '
h01yi.: I'1 'ICJjIA, t;r
y, f r.�:Ic,
i b :.rf! '!, I')d Il),UbliI'l0r1r A. Ift.iAH;le!il 1,0 to2 lt,T
r • ;SY�r;!Srt !}IN,,:,•1U;!f:�,."N 3
v
'f.l1Jh ?" f G.� IJ Jftl ,.i' .T -rf
it+ it � 7h i�13i-I t�•tq r)ifrl.J�ftrr,.„r±(.i,,'') ':I ,
i
r - .•� 1F fS;7,?t.,i rt liTO� i. ;�, �.11�