HomeMy WebLinkAboutSUBMITTED PAPERSAll APPLICABLE INFO MUST BE COMPLEi,�JOR APPLICATION TO BE ACCEPTED
Date: +�-� �� Permit Number:
SCANNED
BY
St. Lucie County
Building Permit Application
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 Residential
PERMIT APPLICATION FOR:
Address: ,e
Legal Description:
Property Tax ID #: ,2�
Site Plan Name:
Project Name:
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Lot. No._
Block No.
Windows/Doors
Roof
Total Sq. Ft of Construction: // Sq. Ft. of First Floor:
Cost of Construction: $ /U� Utilities: —Sewer _Septic Building Height:
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Name �6
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City:/��State:s
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City: State:
Phone •
E-Mail:
Fill in fee simple Title Holder on next page (if different
from Owner listedabove)
or County
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 that
or and covenants 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 o n gent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE FLORIDA
COUNTY OF 6-k. L `lc \ A
COUNTY
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this tea, day of t% %1q . 20AI by
this day of 20= by.
1kd
(Name of person acknowledging)
(Name of person acknowledging
(Signature of Notary P ic- State of Florida)
(Signature of Notary Public-! of Florida
Personally Known OR Prod e E
Personally Known OR Produced Identifi tion
Type of Identiflcatio. NA GIVE
Type of Identification Produced
Y P`'B�� Notary Public -
Oec W 2016
_
if'
Commission No.My Cot
EE 85876pssn.
Commission No. (Seal)
GommisS1Dn
Bonded Through National Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
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. Initial led
I understand that the building official and inspectors are not there to design or give advice on howW 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. Q�
Initial ✓� a�
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 or e
cost of the license. Initial
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 me ical
cost, which could include loss of wages during recovery from their injury. Initial lellt
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
-2,2 day of of 20A.
Own er Signature
STATE OF FLORIDA
COUNTY OF S 3r. %-V -C—% <.
The foregoing instrument was acknowledged before me this D� day of d► J� , 20±,
by q Q N 9, %)'%-,L who is personally known to me, or who has
produced C Q. 60 — "N bb C c% 30 4 - a as identification.
r.•� }+ ftc�,n v� �Ik DEANNA GIVENS
Signature of NotJ# Type or Print Name of Notary ;?�� °� ; �g ly)Public - State of Florida
Title: Notary Public Commission Number C $5cl ' • ; My Comm. Expires Dec t6, 2016
J:' 'oe� Commission EE 658761
°F ,`` Bonded Through National Notary Assn.
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SLCPDSD Revised 05/15/2014