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Home My WebLink AboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:J7 Permit Number: / 0717 7 ?IV f:=v rte'+ WED ia rl i Building Permit Application APR / 7 2017 Planning and Development Services Building and Code Regulation Division 2300-Virginia Avenue;-Fart-Pierce`FL 34982 - - Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: . v i fY1 lil I IZ(vC, tl: -' i,P'o q Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Additional wor to a pe orme under this permit-cheCK all tat appy: Mechanical Gas Tank Gas Piping Shutters Windows/poors. Electric Plumbing Sprinklers Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: . Cost of Construction:$ll - Utilities: —Sewer _Septic Building Height: Name Name: Address: I•- Company: City: Ir c State: ::Z Address: Zip Code: '-4 01 Fax: City:State: Phone NoZip Code: Fax: E-Mail: V k z r, h oo Ke., -RS e t ja,'2,, 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. 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 nori-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 commencin work or recording our Notice of Commencement. S,igr,k?Jureofi0r ,/Lessee/Contractr as Agent for #vn7 ` Signature of Contractor/License Holder STATE OF FLORID LL STATE OF FLORIDA COUNTY OF g zZ COUNTY OF w zTheforinginstrutwasacknowledgdbeforem ¢ a The forgoing instrument was acknowledged before me this day of 20LC—.by this day of 20_ by gw v M rG1 Name of person acknowledging) Name of person acknowledging) Sig 07 ture N Public- ate of Florida)Signature of Notary.Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. Seal) Commission No. Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Fe—v. Planning&Development Services Department COUNTY Building&Code Regulations 2300 Virginia Avenue Fort Pierce,Florida 34982 772)462-1553 OWNERBUILDER 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 your 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 applicable-- laws,ordinances,building codes,and zoning regulations. Initial r I understand that the building official and inspectors are not there to design or give advice on how to meet- 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 foLikel cost of the license. Initial k, 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 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 DepartIRprit to the Florida State Department of Professional Regulation. Signed and acknowledged on this dayo of 20 wnerBuilder Signatur STATE OF FLORIDA COUNTY OF The flore2ging ins ent was ac qw dged before me this day of 2Q_ •, by d G{-)''3,le,k V (Q G- 1 N• who is personally known to me,or who has produced—r"-tiQ •n as identification. a re o oUfypeorHintNarhe of Notary Seal) Title:Notary P is Commihfion Number SLCPDSD Revised 05/15/2014 jr'Pac AUDREY B.HUMPHREY MY COMMISSION 4 FF 174772 EXPIRES:March 6,2019 f Q' Bonded Thru Notary Public Underwriters