HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLp�
DATE FILED: o�—a—
PLAN`f
REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
= PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVWON
2300 Virginia Avenue qNN
Ft. Pierce, FL 34982-5652 @ }. ��
772-462-1553 St CUcie cc) my
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. I LOCATION/SITE ADDRESS: 9406 Rryo it l i ti Y A v-+
2. r PROJECT NAME: SITE PLAN NAME:
3. 11 PROPERTY TAX ID#: 0/-60A-02gy, /00-
4. p LEGAL DESCRIPTION (attach extra sheets if necessary): L A kE Go 0 e d PA• Ir vet., / 8 4S
LOf CAjOP /3fo,I u) or 3y9o- `/8Y)
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. I PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: OL7 S 1 z, l P , / 3 0 r
10. It COMPLETE TE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
F7 'b., , M -el 1, / D? .S o O /"-f -�c `I ' f T! 1 c
11. ®SP-TBACKS (ACTUAL) FRONT: BACK -- GHT SIDE: LEFT SIDE:
JJis'�'A�ICE'f'�0 I�rl��
12. TYPE OF CONSTRUCTI N ( heck al ap ro a oxes)
�Q NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[� RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) �AI
13.(V DESCRIPTION OF PROPOSED USE: !C A r
14tV SQ. FT OF CONSTRUCTION: L- b 15. SF. FT 1st FLOOR
16. 4VALUE OF CONSTRUCTION: $ D G
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question aad/or modify the indicated
value of construction ifitis demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or morn, a
RECORDED Notice ofCommrneenlMi must be submitted with this application.
SLCCDV Form No.: 001-02
s
j
UPDATED 6/25/09
I
OWNER INFORMATOON
NAME: R/c�Air� .tl/ r� 14Aty %/l.OAA
ADDRESS: ® �2 $ /2 S /0 r4
CITY: rc� STATE: FIA ZIP: 3 VT 9 i
m'
PHONE (DAYTIME): .2 0 /— 9 G V 4 Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (�
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: p ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYT L—) FAX NO. Email:
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
610409
STATE:
STATE:
ZIP:
M
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you -by mail.
{
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CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE 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 YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. '
GZNUMR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF St LUC ie
The foregoing instrument was acknowledged before
me this A dayof Tup.r 20 0 ,
by APchard flleinn
who is personally known ✓or has produced
as identification.
(��� � ���+n� ,�7o�
�-t11y" t.Ita&%
Signature of Nota
°
CONN
Commission No.
y
Commjssi�&#dip691196
pires Auguslc3
1, 2013
gagdTmy Fan hBW,i8S7078
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
me this day of
by
who is personally own
Sigp'blure of Notary
Commission No.
:knowl ed before
20�
or has produced
as identification.
(Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR.TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
,
For specific illptructions see appropriate permit shecklist. i
i
PLANNING & DEVELOPMENT SERVICESDEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
/301- Gob - 6FAC/`/-/0�-6
(Parcel Id#/Legaldescription/Add ess
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge.
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community RILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
A XAWAIJ C✓, & A— /i'hAA,
Property Owner Name (Please Print)
*0 X44 ,/ %)U . 6 /6 /3
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF 54' LtcG t'-
ACKNOWLEDGED -BEFORE ME THIS 16_�h DAY OF 1714"e— 120 13
BY Richard Mal1n WHO IS PERSONALLY KNOWN TO ma V**"ORWHOHAS
PRODUCED
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SIGNATURE OF NOTARY PUBLIC
0 0 841116 COmRvHssION NUMBER
(SEAL)
SLCPDSD Reviud 08242010
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CONCflETE PRODUCER IN FLORIDA
MAIN OFFICE:4300 S.W. 74th Ave.' Miami; FL33155
PHONE: (305) 262.3250 - FAX: (305) 267-M
SERVING MIAMI-DADE, BROWARD, PALM BEACH, MARTINI& ST. LUCIE COUNTIES
MIAMI•DADE: (305) 264-7101
DEQRFiELD: (954) 480.9333
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MAIN OFFICE: 43M S.W. 74th Ave. - Miami, -FL 33155
PHONE: (305) 2623250 - FAX: (305) 267.0698
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planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2172 Fax 772-462.6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
34451
PERMIT #: I Z C6 Z JOB ADDRESS: T90<6 '�Cooyliyw
BUILDER/CONTRACTOR: I0, a ,l M&t011
PEST CONTROL CONTRACTOR: — - G'
PEST CONTROL LICENSE #:
We, the undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in accordance with the standards of the National Pest Control Association.
Square feet if area treated: 3100 5/F Chemicals used:zal-2s c�
Percentage of solution:
Date of Treatment: % - Z 1— I
_Footing
Sn Treatment
!Re -Treat
Driveway
is' Treatment
Re -Treat
_Other uti n_ k�6� jA
_6,1� Treatment
Re -Treat
Total gallons used: 3
Time of Treatment: I' 3 0
_Slab
_ln Treatment
_Re -Treat
,Pools
is'Treatment
Re -Treat
F �( �_/ Perimeter for Final Inspection
��I.aUtiil�/ o G�iL.GJ
Signature of ExtermlVator
Note: There must be a completed form for each required treatment orm-treatment and this form mustbe on tine jab
site to be picked up by the Inspector attune of each inspection or the scheduled Inspecdon w111 fall and a•re•inmection
fee charged.
FBC104.2.6CerhffmteafProtMUveTfeatmentforpreventionoften?ekes. AWeatherreststantjabsitepostingbaard
shall be provided to receive dupllcate Treatment Certificates as each required protective treatrrrent Is completed,
providing a copy for the person the permit is issued to and another copy far the bullding permit files. The Treatment
Certificate shall provide the product used, Identity of the applicator, time and date of the treatment, site location, area
treated, chemical used, percent concentration andnumberofgallons used, to establish a verifiable record of
protective treabnent. If the soil chemical barrier method for termite prevention Is used, final exterior treatment shall
be completed prior to final bul/ding approval
St Lucie County requires for the final inspection for C®, a permanent Sticker to be placed on
the electrical panel box cover, listing all the treatments and dates of applications.
Planning & Development Services Department
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 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 applicable
laws, ordinances, building codes, and zoning regulations. 1 Initial
I understand that the building official and inspectors are not there to design or give advice on hoAv to meet
the minimum code. I 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 maybe responsible and liablg for the
cost of the license. Initial N or
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
Zoging Departm ntft to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of_of20 G/
Owner/Builder Signature
STATE OF FLORIDA
COUNTY OF /
The to oinig instrument was acknowledged before me this day of.P. ,L� 20
by who is personally known to me, or who has
ced produas identification.
d
Signature of Notary Type or Print Name of Notary="� =" -(Seal)
Title: Notary Public Commission Number Q tiP"' "�A'•. ^ DAWN MILONE
�� ��= Notary public - Slate of Florida
a . •; My Comm. Ex ues Mar 22, 2017
SLCPDSD Revised 05/15/2014^9 I o,: P
For v�oe,, Commission # EE 877571
Bonded Through National Notary Aesn ;
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