HomeMy WebLinkAboutVOID - BUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
*� Q
Date: J' b SCANNED Permit Number:
BY
'�' �_' ?! I.J , =_J' = �� ��° RECEIVED
Building P it Qication FEB 2 3 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description:
Property Tax ID #: /7� /� S®2 �Z�� ��� �P�^ Lot No. 3�S
Site Plan Name: ^�I Block No.
Project Name: ee
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Ile ee1,f,*e
Ile r
CONSTRUCTION INFORMATION:
AdditionaiworKtobenerformedunder this permit —check all fliat apply:
HVAC ED Gas Tank ❑Gas Piping _ Shutters Windows/Doors
O
11 Electric F-1Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Z S . Ft. of First Floor:
Cost of Construction: $ /OQO Utilities: L__ISewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 40 7/157 ��
Name:
Address: !O �5��
Company:
Address:
City: A- Ar State:5G
Zip Code: 39"9 3�e g Fax:
City: State:
Phone No. —.Z to —
E-Mail: Die pa0q)C&`e&sr•
0
Zip Code: Fax:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County Licenser
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmenrinu wnrk nr rer_nrdinE your Notice of Commencement.
for
Signature Contractor/License Holder
Signature of Owner/ Lessee/Contrjkfor as Agent Owner
of
STATE OF FLORIDA L t 1
STATE OF FLORIDA
COUNTY OF ," `fit
COUNTY OF
The for oing instrum was acknowledge efore me
this Q3day of 20by
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identiflo on
Type of Identification
Produced
Produced
(Signature of NotaryPub - N S. , N I F L S E N
(Signature of Notary Public- State of Florida )
\�" P mi sion # FF 115637
Commission No. ;¢ ' *._ M�t�,mission Expires
ommission No. (Seal)
' 12, 2018
OF June
�1111111``
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
n'
1
Planning & Development Services Department
COUNTY Building & Code Regulations
• a =- 2300-Virgloia 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.
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. You
may not hire anunlicensed 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. 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 a 1le
laws, ordinances, building codes, and zoning regulations. Initialp
I understand that the building official and inspectors are not there to design or give advice on hoy�jtv`� t
the minimum code. Initial
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
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 r : e
cost of the license. Initial
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
cost, which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection, an owner must personally appear and 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 Deptthe Florida St a Department of Professional Regulation. Signed and acknowledged on this
day of Grp of 20%'
STATE OF F]
COUNTY OF
by
Title: Notary Public
SLCPDSD Revised 05/15/2014
O erBuilder Signature
before me this _Qa day of 20§----,
who is personally known to me, or who has
as identification.
Type or Print Name of Notary
Commission Number
KA R E N S ,
NIELSEN
*_ Commission N FF 115537
My Commission Expires
°F1 June 12,
2 01 8
(Seal)
VOID