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Home My WebLink AboutSUBMITTED PAPERSDate: / q1 1 Y1 Fee Due: 1X0 ,Cp 4 1 Receipt# I a.1i I Permit # Pi 0-34, CQ, t Q Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SCANNED BY St. Lucie County ... _..... ... .._.... -......... ..... .... ...._.... ...... --..............._.... _........._..... ..... ................. ..... ........ SPECIALTY---EPLICATI,OX...... ......... ..... ._............_.._.._.__..._............._._._.....__............_ _ ❑ Electrical ,Plumbing ❑ Shed ❑ Demolition ❑ HVAC ❑ Fence ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: jj� ,( �` 2. Parcel ID Number: SLID gL`v Office Use Only Section Township Range Map Page Zonfag Land Use Initials 3. Complete Description of Project or W 4. Owners Information 5. Contractors Information r Name: 'y"/ � p / /VI D Address: (i I / 1 1/�/) Vli� 1� City: , W(.Q C� State: P Zip: 3` _q�P46-5� 6. Value of Construction: S C20 0 FL Reg/Cart #: County Cart#: Business Name: Phone: Fax: VER'.SFIDAVIT: I certify that all of the information contained in this application is correct and that all work wicompliance vrath ll applicable laws regulatty Zx- �t (J v� PRIRT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF in ACKNOWLEDOED BEFORE METHIS =_ DAY OF V'4% oA 20—L-L, BY v A GIVENS S� �+ WHO IS PERSONALLY KNOWNTO ME WHO HAS PROD U 30 5 S rotary Public - State of FloridaMy omm. xpues Dec 14, 2016 AS IDENTIFICATION. � �,r Commission # EE $58761 ' %°; ;� g` Bonded Through National Notary A— SIGNATURE OF NOT Y TYPE OR PRINT NAME OF NOT Y COMMISSION NUMBER SSAW141 NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMII MNCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE.OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500.OD Revised 04/26/2010 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 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 or a commercial building at a cost of under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within one year after the construction is complete, the law will presume that you built or substantially improved it 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. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicab e , ordinances, building codes, and zoning regulations. Initial 4-1 I understand that the building official and inspectors are not there to design or give advice on how to eet 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. 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 may be responsible and liabl f the cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction Joject- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related in . al 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 ownerlbuilder 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 of 20 Owner/Builder Signature STATE OF FLORIDA COUNTY OF'`t-V G t The foregoing instrument was acknowledged before me this X c k day of �q { , 20 , by t R.\ C q�� who is personally known tome, or who has produced: -IC, -!A -SL% - b 3 '1-�Zj as identification. • �� `J �rS DEANNA GIVENS tPFyv P,B:;,i . o � ; Nota Public -State 01 Florida Signature ofNotar Type or Print Name of Notary =_,. •� _ MY D� lkxpires Yec 14. 2015 Title: Notary Public Commission Number [.a S$oe; commission # EE 8 761 Assn. Bonded Through National Notary SLCPDSD Revised 07/22/2010 ST. LUCIE COUNTY UTILITIES.-, P.O.6C'- ,�8' FT. PIERCE FL 34982 l 'NAME ' .! /'., `to St. Lucie County - PCIS .„ accr # 03-19-2014 09:38:53 / 1513%4421 SERVICE ADDRESS: PRADO, MIGUEL 4812 MYRTLE DR FORT PIERCE FL 34982 `SUBDIVISION.. LOT BLOCK Amount Tendered: 518.00 Amount Paid: 518.00 °BILLING ADDRESS - ' 7,d jal Change Due: 0.00 Thank You PHONE,# SG�j�P� MOVE IN/CLOSING DATE. User ID: WARDD =. This application hereby request and authorizes the Utility to render water,and/oc:sewage disposal . i services'to the premises;descnbed above in accbrdanca ''the'Utilrties present or future rates; „•.,, ,,,,..,, w, „ •,.,.,,,,, ,<.,,.�.,, ,, ,,.,,, rules and; regulations, which by reference are made a part of this`contract :AppLcant agrees.to pay. ., 6 an_ Uhhty promptly for such serviced regulations ' f TOTAL `CU N NEGOTIABLE OR TRANSFERABLE:s STOMERS DEPOSITS ARE NO CUSTOMER SOCIAL SEC/ SIGNATURE' � :- _ � �'. , - - FED ID "•. �� NAME OF SPOUSE SPOUSE SOCIAL SEC OFFICE.�USE ONLY , B DATE RECEIVED CASH CHID# RECEIVED s