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Home My WebLink AboutBUILDING PERMIT APPLICATION (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr Date: `1-% 2.-\(t Permit Number: I � � � �� RFC q,6,p i F' F% Building Permit Application s'7 � O Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERMIT TYPE: Address: . 4140F04 Cow nk�PnE Residential V Property Tax ID#: ddr-ID(D Lot No. Site Plan Name: Block No. Project Name: Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: I P 6 Cost of Construction $ 30 ( ') .Wa —Generator Sq. Ft. of First Floor: -Windows/Doors Roof Pitch Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: f ..r., _ _ CONTRACTOR= Name=' N t1 (, W ts- cf Name: Address:yv\l Y7. V- Company: City: i y,o State: Zip Code: 'Ili ^ctg2 Fax: Phone No. Cl y C Address: City: State:_ Zip Code: Fax: Phone No E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. SUF�PLE(VINTAL CONS{TRUCI IONLIN LAW�(VORMATIOI ;; DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Name: _Not Applicable 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Contractor/License Holder Signature of wher/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this j2�,dayof�Q, this_ day of 20_ by ems' '26Aby 1 ''�trC_X�/ Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificatior��r 4- Type of Identification Produced Produced (Signature of Notary P f - State of Florida) (Signature of Notary Public- State of Florida ) Commission No. o"""-.5571 N VAUGHN Commission No. (Seal) �-stat o _ orida-Notary public y? Commission # GG 270079 er 22 2022 ... REVIEWS FRONT PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.2/7/19 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 al(licable laws, ordinances, building codes, and zoning regulations. %nitial pr I understand that the building official and inspectors are not there to design or give advice on to et the minimum code. ;Initial V 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. Ynitial ftLLO 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 lile fo�the cost of the license. CIuitial I understand that if any person that is unlicensedanduninsured gets injured on my construction project - they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer ..aa}�ttiid relat me l cost, which could include loss of wages during recovery from their injury. itial 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 Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of r—� of 20 ,J�_. W tU- 'Olwner uilder Signature STATE OF FLORII;_% COUNTY OF /T- C R in The foregoing instrument was acknowledged before me this 7" day qfqPI�4-7 , 20 by who is personally known to me, or who as produced as identification. �U cu�sY� �tAa ti Vouch) Signature of Notary Type or Phnt Name of Notary Title: Notaty Public Commission Number 6&,M 9 ,zo"''m, ELLENVAUGHN ac State of Florida -Notary public •5 Commission # GG 270079 My SLCPDSD Revised 05/I5/2014 '��'oll1 o`A�� Commission Expires October 22, 2022