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Home My WebLink AboutSUBMITTED PAPERSi ' I All APPLICABLE I FO WIT BE�PLETED F,,. APPLICATION TO BE ACCEPTED Permit Number: Date: SCANNED By �_� �=��:�,.`�"�";� �`�•°�,: fix. '8fi. Lucie Co unty Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: :� () Legal Description: Building Permit Application I Commercial Residential X,1 Property Tax ID #:O("1 -� Lot No. i Site Plan Name: Block: No. Project Name: Setbacks Front Back: Right Side: Left Side: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Cost of Construction: $ 0. 0 d Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: Name Address:'0 ` Y Company: City. Z '' Stater Address: Zip Code: 5A q Fax:/ l City: Phone No. 9 �,2 , / �-Z ,/� / Zip Code: E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail from the Owner listed above) State County License State: Fax: iIf value of cnnctructinn is 75nn nr more- a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name:_ Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: 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 commencing work or recording our Notice of Commencement. Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 'k- G``e COUNTY OF The fpr ing instrum t was acknowledg 4jiefore me The forgoing instrument was acknowledged before me this ay of �( 20LD by this day of , 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of N T3Public- State of Florida III (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Iden ' ' t'on Type of Identification .•'r'p'� ANGELAM.HUFF Produced ProducedMTW"MI9SSlON#EE083530 'R' ' EXPIRES: April 12, 2015 '� `�' Commission No. (Seal) Commission No. ^. ••••�� Bonded REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. Planning & Development Services Department e Building & Code Regulations ® 2300 Virginia Avenue ti 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 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 p able 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 how the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial 7a1'i I understand that if I.compensate any person or company for work performed they .are re licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction 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', 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 Dep nt t t Florida State epartment of Professional Regulation.. Signed and acknowledged on this day of of 20 , 1 STATE OF FLORIDA �L uo COUNTY OF AT- The foregoing instrument was ackno ledge before me this day of r 20 by (� who is personally known to me, or who has produced as identification. ULF Signature ofN Title: Notary P SLCPDSD Revised 05/15/2014 iype or Prim Name c Commission Number (Seal) ANGELA M. HUFF -I +: MY COMM2SSION # Et= 083530 a; ......... EXPIRES: April 12, 2015 RF�tk ' Bonded Thru Notary Public Underwdteno ems;