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Home My WebLink AboutSUBMITTED PAPERSOFFICE USE ONLY: DATE FILED: 4; 1 st, I REVISION FEE: 1. LOCATION/SITE ADDRESS: PERMIT # 1 105 ' 4 0 b RECEIPT # a PLANNING & DEVELOPMENT SERVICES s cS'C eBUILDING &CO2300 DE IlVIGAUI TNIiO�N DIVISION IX �+4 FORT PIERCE, FL 34982-5652 (772)462-1553 CO APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION r n 2. DETAILED DESCRIPTION OF PROJECT 3. 4. 5. CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: _ BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: PHON AYTIME): OWNER/BUILDER INFORMATIO NA ADDRESS: -% CITY: PHONE: "r172 ?SST SSG ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME): SLCCC: 9/23/09 Revised 04/26/2010 ST. LUCIE COUNTY CERT. #: STATE: ZIP: FAX: STATE: > ZIP: FAX: STATE: FAX: ZIP: Fee Permit # Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Fax 462-1578 SPECIALTY PERNUT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ® Fence ❑ Shed* ❑ Demolition ❑ Gas ❑ Siding -k4 le L�' Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 7 8o S fC,c, IC i s A d e 2. Parcel ID Number: i-S®l - 6 0 `i a I `l l O o o- 7 3. Complete Description of Project or Work: PC J a L`1O 4CN d oe- l ? Car— C 7tQ L-qu 4. Owners Informah n 5. Contractors Information Name: %%%r e. , fe 1 -S - 4-rc� PQ— FL Reg/Cert #: N Address: s `(A' - City: iCl, f 9,4-0-- State: � / Zip: 3 y 95 Phone: 6. Value of Construction: $ 1 S� County Cert#: Business Name: Phone: Fax: OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance with all applicable laws regulating construction and zoning. PRINT OWNER OR CONTRACTOR NAMES SIGNATURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ��rr�� P CCU i ACKNOWLEDGED BEFORE ME THI�q DAY OF •J 2011�, BY M oFOn �AIiD Y1 WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED �—�LtL��oal0 • �J i • l03 Ala o *NTURE C TION. OF NOTARY TYPE OR PRINT NAME OONOTARY _. COMMISSION NUMBEFT -C6'66 0 LASHAHNAINGRAM MY COMMISSION # EE 050558 �RES: December 20,2014 n e Thru Notary Public Underwriters *ALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED TO MEET THE FLOOD ZONE ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on reverse side of this sheet) Revised 04/17/2014 NOTICE TO OWNER: FAILURE .- RECORD A NOTICE OF COMMENCEMENT 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 $7,500.00 1 INSTRUCTIONS ' Please complete all information in the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The information to be provided with this application includes: 1. Location/Site Address 2. Parcel ID Number 3. Description of. Project or Work Activity 4. Owner Information 5. Contractor Information 6. Value ,of Construction Indicate the street address or general location of property where the building activity is taking place. Indicate the tax identification number of the property where the building activity is taking place. Fully describes the activity to take place. Indicate the name and address of the owner of the property on which'activity is taking place. Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name of the business doing the work. Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the buildirig/construction activity. Construction value is used to determine the permit fee. St. Lucie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction. ❑ Gas Attach 2 piping schematics with tank size,location, and BTU of each appliance ❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications ❑<HVAC_= No attachments necessary This.applicatio cah be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications will be accepted for processing after 4:30 P.M. For assistance in completing this application, please call (772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. Upon issuance of this permit, required inspections can be scheduled by calling 1-866-284-1280 or logging on to http://codeinspectionpubIic.stlucieco.gov/ in M-11 C tt Planning & Development Services Department Building & Code Regulations o s 2300 Virginia Avenue 1" - � _ 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 appli s, 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 to 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. Initial C�f 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 liab or the_ . --- 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 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 Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this 29 day of 3 of 20 ,�: Owner/Builder Signature STATE OF FLORIDA , COUNTY OF2kl- , �® The foregoing instrument was acknowledged before me thi3,q day of M11 A 2014, by C. who is personally known me, or, who has roduced tD 6 as identification. S ature of Notary Type or Print Name ofr�T'rotary) I.ASHANNA INORNN Title: Notary Public Commission Number LG �ds� �= MY COMMISSION k EE 050558 P,: EXPIRES- De, 2 Bonded Thru Notary Public I1 denvrit_ SLCPDSD Revised 07/22/2010 r L AKEWOOD PARK UN/T NO. 4 gEWS A .F/SDrW O ALL OF M£ AORMREST pUART£R OF t!(E Sw!/NEAST UUIRTER. ,WD ALL W ME SOUTNREST OUARMR OF Mf AORN/FATT ptl - ARU AIL.. Of Mf. SUUMEAJT w lm OF M£. •ORMfLST R�'O .r! LYlN6 W SECnON !! .. i TpYA(9SD JISWMG R.M6E S9 EASI, SC LULF L� PLATBOOK O, PAGE2 LGWTY?'ST.LCt/E �� IKI�ro xlle�ll'lb KI s,m.>aoRe,v?`._GWa1.IOY_ is/�roRw— KY tl��[�+17 �tC�I,1F aPY�[i�_o4b l� l P IS r.hLm (fRRfKa IE [rRERL'OFC%R1TL'UUR/ sE� raa of we m�aR rum m.N/ ENduEfRS cmMw./r'�^; ,:� wf=' SLATE crMRIRa '.:',G�:::•�'�: ;. . WA'IY OFln9laNRrvfR . i L all 11, s✓iw y::.. SMIA- Kwe char ro ¢arUllxn . SORws ®�sE o�Y SFJ✓l V APPlicant has been advised NO structures can be erected within any easement or right of way unless o se approved. APPlicant Initials r � \ I I I 1 6 0 /avIc-