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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 30-17 I All 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 2300 Virginia Avenue,Fort Pierce FL 34982 a Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PR®POSiED tNPR®UEMENT LOCATION: n Address: Legal Description: /fQEef/lic�/f/�/.�-1-7' Property Tax ID#: � � �� • _01 �W� 000� Lot No. Site Plan Name: i Block No. Project Name: ,r Setbacks Front Back: Right Side: Left Side: DETAILED DE1SC lPTtON Of WORM: I i C®NSTRUCTIO'N INFO'R AT � N: Additional work to be perrormed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: .Cost of Construction: $ /3d©.� Utilities: —Sewer Septic. ; Building Height: i OW'NER/ EE: C©NTFRR_M Name ! Name: Address: Company: City: dC111,014;r State;Z- Address: 1' Zip Code:.Wggf j Fax: City: I State: Phone No.Z7/ 9 y Zip Code: Fax: ' I E-Mail: Phone Phone No Fill in fee simple Title Holder on next page (if different E-Mail i I from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement'is,required'. 1 i Planning&Development Services Department Building&Code Regulations • 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 OWNERIBUILDER 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 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. 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 1'cable laws,ordinances,building codes,and zoning regulations. Initial I understand that the building official and inspectors are not there to design or-give advice on ho t eet 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 lia or the 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 relat dical 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 disclosures 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. Signed and acknowledged on this day of of 20 1-1 . O e 11der-Signature STATE OF FLORIDA COUNTY OF The oing instrument was acknowledged before me this 3b da�, to 20-01 by who is personally or who has duced as identification., r Signature of Notary Type or Print Name of No ry (Seal) Title:Notary Public Commission Number HNA 1NGRA� ; � ��Sublic State of Florida SLCPDSD Revised 05/15/2014 `oPav' *(c,� Notary F Expires pec 20,2018 :My comm FF 177249 ,. ' Commission# ota, Assn.( National N , of f,��' Wlded lb�ou9 y ,i y i . t it i' 'IIk , lIi f Ili l i I� 1 i 1 I I'.All i4 t Applicant has been advised NO stnicturos can be erected within any easement or right of way,unless otherwise,,approved. Applicant Initials.- i� i, I r r