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Home My WebLink AboutSUBMITTED PAPERSFee Due: _ ermit # ❑ Electrical ❑ Shed* NOV � Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. SC Fort. Pierce, FL 34982 q (772)462-1553 Fax 462-1578 S �4 C�� SPECIALTY PERMIT APPLICATION C°%L' /IQ Plumbing ❑ HVAC ❑ Fence ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 5361- Z9214 —A dgk A/C i 2. Parcel ID Number: 3. Complete Description of Project or Work: &l.,'/TY/z' 4'u� 4. Owners Information 5. Contractors Information Name: y d.�-B�7 �,.(l y�,a liL FL Reg/Cert #: Address: <G/ O cSi11VJ'e7-- A/i l40 City: lq—,�,�f2(_e, State: /6�L County Cert#: Business Name: Zip: Y11 P2— Phone: 22 /' rjdS- fy s Phone: Fax: 6. Value of Construction: $ AM �- OWNERS 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 zonink A Adlhy� PRINT OW11ER OR CONTAACTORN�AME GN F O R CO CTOR a STATE OF FLORIDA, COUNTY OF& ACKNOWLEDGED BEFORE ME THIS DAY O 20 B�Y�' `�y� 1. WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCEDI L!L �i`1Q 4iZ'Sa'3 ' AS ENTIFICATION. S A OF NOT TYPE OR PRINT NAME OF OTARYLkWMNA INGRAM COMMISS ION NUMBER OSd MY COMMISSION I EE 050558 <= EXPIRES: December 20, 2014 . .. Bonded Thru Notary Public Underwriters 'BALL 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: FAILUR . _,'i RECORD A NOTICE OF COMMENCEMENT 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 $7,500.00 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 building/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 application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 3;49.82.: All;perrnit applications must be filled out completely before submission. No applications will be accepted,for.processirig'after 4:30 P.M. For assistance in completing this application, please call (772) 462-1'553,.'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 1-8.66-284-1280 or logging on to http://codeinspectionpublic.stlucieco.gov/ Planning & Development Services Department Building & Code Regulations 2300 Virginia Avenue Fort Pierce, Florida 34982 (172)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 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 b e laws, ordinances, building codes, and zoning regulations. Initial j I understand that the building official and inspectors are not there to design or give advice h to eet the minimum code.. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I m t 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 uired to be licensed in this jurisdiction. If for _ some reason they do not possess a.license, I may beresponsible_and-1: a for the. - _-- cost of the license. Initial Im I understand that if any person that is unlicensed and uninsured gets injured on my cons tion project - they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and rel 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 si 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 acknow ged on this A day of OVA) e- of20L,�_. 1___? Signature STATE OF FLORIDA COUNTY OQ�& The Foregoing instrument was acknowledged before ire this &L day oi:F- � , 20 14 , by who is personally known - to me, or who has roduced WL W4;& ii� t -,S& 30 • D as identification. Si%gnature of Notary Type or Print Name of Notary Seal Title: Notary Public Commission Number a AgDSS� ,,yip LASHAHNA INGRAM s ..' MY COMMISSION # EE 050558 EXPIRES: December 20, 2014 SLCPDSD Revised 07/22/2010 `''.;pF Fyd ' Bonded Thru Notary Public Underwriters WATER COMM SEWER RES J �n METER SZ. M/F IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTALL.' CFC/WATER FPUA CFC CFC/SEWER GUAR. REV. LATERAL S rC TOTAL CUSTOMER l SIGNATURE NAME OF ySPOJJ E _ DATE ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE FL 34982 NAME S� [) AVg1jLC/ A IV,0 , f� IC11 /-{ eLJ�� ACCT. # SERVICE ADDRESS �G/�/j/� �,(J; �9,�� ,J& SUBDIVISION BILLING ADDRESS._SZi M' J,! LOT BLOCK PHONE # -772 - -I&(Z <a MOVE IN/CLOSING DATE This application hereby request and authorizes the Utility to render water and/or sewage disposal services to the premises described above in accordance with the Utilities present or future rates, rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay the Utility promptly for such services in accordance with the established rules and regulations. CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. SOCIAL SEC/ ! l FED ID _ 7 ?0 - SC/ . 7 911 SPOUSE SOCIAL SEC. OFFICE USE ONLY - CASH CHK # RECEIVED BYft o O O 0 0 0 co co 0 co ti Ln LO � m U - 0- N fV CD W O 0 co +>'-' = 4Q H O Od m C1 U V' C/7O Z LL'O -O -• CZ)J � 00 O?U W ro O O ' N FO- d' CM O -_ UN mJOHm } O JN ¢[Od0 4-4- m H cc•-- i=- X O 7 C 'c IO I CO