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HomeMy WebLinkAboutSUBMITTED PAPERSiI ALL APPLICAIBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED bate: LA 1 ol Is- SCANNED Permit Number: By Lucie County. s Building Permit Application Planning an Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT AOPLICATION FOR: To Select from dropbox, click arrow at the end of line Plu a`bing Address: Legal Descri Property Tax D #: o` �-% o� - -1o a, ° 00 O l ^ 6 o o P q Lot No._ Site Plan Na e: Block No. Project Name: Setbacks Font Back: Right Side: Left Side: ©o k P c Additional work to be •ertormed under this permit —check all apply: E1HVAC Ei Gas Tank Gas Piping _Shutters Q Windows/Doors 11 Electric L`J Plumbing Sprinklers Generator Roof Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Const uction: $ ac'cp Utilities:Cn Sewer FI Septic Building Height: OWNER/LESSEE: C«ONTRA.CfiO.R: Name 1-'zle1 e- CT Name: Company: d1nb2 Address: `� Ft' a �"� 2 C P__ City: 1 � C'g' C e State: F Zip Code: �i9 a Fax: Phone No. a - - in�1 Address: City: ce- State: Zip Code: Fax: Phone No. 1 DL -LA O c E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: State or Co ty License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Sl1PPLE 12 CO.N TRLI ION Lt'EN LAW ; , FQ MATtON;. DESIGNER/ENGINEER: Name: Address: City: Zip: Phone: _ Not Applicable State: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: Address: _ Not Applicable BONDING COMPANY: Not Applicable Name: Address: City: City: Zip: Phone: Zip: Phone: 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 cUlllfIt[ larl WUf K Ur I eL;U1 U11119 YUUr INUIM2 UI lAmmencement. nature of Owner/ Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA / COUNTY OF ,�c�� The forgoing instrum nt was acywled$$ed re me this �ay of 2CI Eby person acknowledging ) (Signature of Notar�ff ublic- State of Florida ) cation Type of ��01I �; EXPIRES: Co m m i ss<rap_i�6�4, � Bonded Thru Not, Revised 07/15/2014 STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of 20 by of person acknowledging) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Type of Identification Produced Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS Planning & Development Services Department Building & Code Regulations 2300 Virginia Avenue 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 emption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even )ugh you do not have a license. You must provide direct, on -site supervision of the construction yourself. You iy build or improve farm outbuildings, a one -family or two-family residence for your use and occupancy. You ty also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own e or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building. you sell or lease a building you have built or improved within one year after construction is complete, then a mumption is created that it was built or improved for sale or lease, which is a violation of this exemption. You ty not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is ur responsibility to make sure that people employed by you have licenses required by state law and by county or micipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed ntractor who is not licensed to perform the work being done. Your construction must comply with all applicable vs, ordinances, building codes, and zoning regulations. Initial 5 0 Ca I understand that the building official and inspectors are not there to design or give advice on how to meet minimum code. Initial 'SflG I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial ;r D G 1 unaerstana tnat it 1 compensate any person or company for work performed they .are required to be used in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable for the of the license. Initial cy D C, I understand that if any person that is unlicensed and uninsured gets injured on my construction project - may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical which could include loss of wages during recovery from their injury. Initial StG- To qualify for this exemption under this subsection, an owner must personally appear and sign the building application and initial the above. I hereby acknowledge that I have read and understand the above disclosure statement and that I further tand that any violation of the terms of the owner/builder exemption shall be reported by the Building and Department to the Florida State Department of Professional Regulation.. Signed and acknowledged on this day of of 20 V�_ r 69,VnerBuilder Signature STATE OF FLORIDA ��L�c� COUNTY OF The foregoing instrument was acknowle ed before me this l may of 20, by GC' who is personally known to me, or who has produced as identification. ASig afore of N tary pe or rint am of Notary I Title: Notary blic Commission Num r ,•vie" ANQELA M. HI1FF '* :si MY C0MWSSI0N # EE MW 4' EXPIRES: SLC ot�ry uDSD Revised 05/15/2014 ' Pf; 4d Sonded lhru N ry P12, 2015 blic Undenvdters Fort'Pierce Utilities Authority "Committed To Quality" Key Accounts 206 S. 6th Street Fort Pierce, FL 3 984-3191 Job Location: 957 FRA MAR PL Account Name: JANICE D GRIMES Contact Name: JANICE D GRIMES Billing Address: 957 FRA MAR PL I Phone: 1772)465-3027 Fax: ( ) - Cell:( ) - I Phone (772)466-1600 Fax (772)467-3115 Invoice Number: KA-33-15 PC N: 242770200010009 LoclD: 10003331-242234 FORT PIERCE FL 34982 Cust Type Residential City Limits Outside # Size Descriptions ' - Fees 1 3/4" Water Meter and/or Service Installation $800.00 Water Security Deposit $60.00 Water New Account Setup Charge $40.00 Water Capital Improvement Charge W ERC's 1.00 T, $920.60 Wastewater Security Deposit $0.00 Wastewater New Account Setup Charge $0.00 Wastewater Capital Improvement Charge WW ERC's 0.00 $0.00 Lien Fees 0.00 Colnstruction Cost Estimate. Fees -; 0.00 0.00 Description for Total Paid: service order: �ow- INSTALL SERVICE AND 3/4" WATER METER Date Paid: ley// Down Payment: $0.00 Invoice Total: $1,820.50 Check Number: Customers will be a Charge is paid - whi customer and Is not Construction cost esti the project. Should ui construction conflicts, percent of the total as refunded by Fort Plan Reviewed By: Customer's Sig Printed Name: 3sed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection ver is first. The cost of the service line from the point of delivery at the property line to the house/building is the responsibility of the uded in this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank the'Health Department at (772)8734931. ates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of weseen circumstances be encountered during construction, including but not limited to adverse weather conditions and ie customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) hated construction costs shown above. Estimated costs paid by the customerthat exceed the actual cost of construction will be Utilities Authority. Kurtis Strand Key Accounts Specialist Date: 03/11/2015 r Date: cla�n`, ce, G r i vY, es