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Home My WebLink AboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^o3 w o) � ✓\ Date: Permit Number-owing �/ (� 0 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: ROTC SEDYIIVII�ROVEMENT LQCA7' N; Address: a 2, Property Tax ID#: 3 d 2" ��qy VOO—U Lot No. Site Plan Name: Block No. Project Name: eker am oy ; C AD �10 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: $ Utilities: Sewer _Septic Building Height: OWNER/LESSEE C .NTRACTOR: Name Name: Address: 52M 5 Company: City:2 f* PIPXC,g_ State:�,. Address: Zip Code: 3145191 _Fax: City: _ Phone No. g9 LA�ifi3 E- Zip Code: Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail j 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. 7d( SIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable me: Name: ress: 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 attorngy before commencing work or recording our Notice of Commencement. Signature of C trac or-or Owner Builder as applicable STATE OF FLORIDA COUNTY OF ,S� L-J Sworn o(or affirmed)and subscribed before me of h�-�P ysical Presence or Online Notarization this (.day of 1911� 20 2'I� Name of person making statement. Personally Known OR Produce Identification Type of Identification Produced e (Signature of Notary Public ate of Florida) OZ 'go Aienjge_q Commission No. Seal ( ) [OL:68tZ x3 uolsslwwo0 Aye HH M u0isslwwo0;o eiel$0,Ignd AielONjl ne d3Hlb3H ,",G�"��` REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev 10112121 ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION St, Lucie County - PUTIL 03-17-2022 10:46:05 21777/5273 PETERSEN LAWRENCE NAME C?\,j V,cv FORT PIEOCE 34982 ACCT.# �i 1 Amount Tendered: 521 .25 Amount Paid: 521 .25 SERVICE ADDRESS Change Due: 0.00 Thank You User ID: MURRAYA SUBDIVISION <_ l LOT n BLOCKf�a TER INSTAL BILLING ADDRESS ] L` .� � �'1 . � r-yc ' ~' 31-I Ci �- CUSTOMER COPY :/WATER EMAIL ADDRESS: t;_ C v° �.t'� EA V-� 4`n JA CFC PHONE# LI �-�- r 4? r "� ls' J MOVE IN/CLOSING DATE CFC/SEWER GUAR. REV. This application hereby requests and authorizes the Utility to render water and/or sewage disposal services to the premises described above in accordance with the Utilities present or future rates, rules and LATERAL regulations,which by reference are made a part of this contract. Applicant agrees to pay Utility promptly for $ TOTAL such services in accordance with the established rules and regulations. CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT APPLICANT'S PROPERTY,REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE. CUSTOMER SIGNATURE >' " " SOCIAL SEC/FED ID 7/ _ C_� NAME OF SPOUSE �_ i ✓� �� U / �' �� f SPOUSE SOCIAL OFFICE USE ONLY DATE RECEIVED J✓ � �� ( �� ✓� CHECK# RECEIVED BY ;�' ��o L��L1�Q15 O 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. 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, zoning regulations. Initial Here. I understand that the building official and inspectors are not there to design or give advice on how to me 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. 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 o 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, re. could include loss of wages during recovery from their injury. Initial He 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 tote Florida State—Department of Professional Regulation. Signed and acknowledged on this day of of 20 OwnerBuilder Signature STATE OF FLORIDA COUNTY OF dk wL1L The foregoing' strument was acknowledged before me this Vday of/1?!q)C" ,20 Z by who is personally known to me,or who has produced as identification. Signature of Notary Type or Print Name of Notary (Seal) Title:Notary Public Commission Number 9ZOZ '90 Aienjga.4 sejldx3 uolssiwwoo Ayq OL68LZ HH 0 u01ss1ww00 _ eppo,A;o e1e1S-oilgnd AJe3oN%;�ndA1`1,� OH03Hf18 H3Hit13H '"��"