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HomeMy WebLinkAboutSUBMITTED PAPERSt Date: l 3 Fee Due: Recei t# Permit # 30 -aQ�a Planning & Development Services ,SC Building & Code Regulations Division B y 2300 Virginia Ave.: St' Fort Pierce, FL 34982 uele Coon (772)462-.1553 fY ❑ Electrical lambing ❑ HVAC ❑ ]Fence ❑ Shed ❑ ]Demolition ❑ Gas ❑ Siding Seepage 2 forr Instructions and additional paperwork required for specialty permits 1. Location/Site Address: Y �'G�NS '�` Re L U Q , J ► I Edt e ('�i F L 2. Parcel ID Number: J �— r `� —l� �©©0 1 Office Use Only Section TowasWp Range Map Page Zoning Land Use Initlals 3. Complete Description of Project or Work: . W k ►--A& r.A� ( 7;k 4. Owners Information y� 5. Contractors Information Name: 5 FL ReglCelt#t;` Address: % .S 5�1� &%) P County Cert#: City: 'Ei r if -PC#- State: r't` Business Name: Zip: Phone:%%#L q&f7710 Phone: r 6. Value of Construction: S � x 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. IL1ftVnkY t r3 s OWNER OR CONTR?iCTORNAME SIGW���]NTRACTOR STATE OF FLORIDA, COUNTY OF - ACKNOWLEDGED BEFORE ME THIS DAY O 20 �3 . BY WHO IS PERSONALLYKNOWNTO MEOR WHO HAS PRODUCED O► W �+11 T O4 C ��� " Aye " , S IDENTIFICATION. `SPµY DEANNA GIVENS ,1l. `-; Not�r �iblic -State of Florida %SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY • !Q My Comm. Expires Dec 16, 2016 tA�J'b'1�D I 'AA—F- Commission # EE 858761 COMMISSIONNUMBER Bonded Through National Notary Assn. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR.PROPERTY. IF YOU INTEND To OBTAIN FINANCING, CONSULT; WITS YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE.OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500-M Revised 04/26/2010 �r St. Lucie Cry Building & Zoning Department 2300 Virginia Avenue Fort fierce, Florida 34982 (772)462-1553 OWNEWBUILDER 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 applicable laws, ordinances, building codes, and zoning regulations. Initial l 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 �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 liable for the cost of the license. Initial _42;�_ 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 relate&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 day of uL of 20 / _)omO uilder Signature F STATE OF FLORMA COUNTY OF 4lC - NAJ The foregoing instrument was acknowledged before me thisday of a q , 20_L6_, by VT% k 1A-.% v4 {' R w 4k%- v' who is personally known to me, or who has produced t i!r�as identification. 7��`,pub°p�,/. Q, �11y� t.r lV� >+ti-S PpY PV , DEANNA GIVENS :. , o Notary Pub&a�fate of Florida Signature of Notai Type or Print Name of Notary My Comm. zpires Dec 16, 2016 Title: Notary Public Commission Number ��� as Commission # EE 858761 O,O �� 60 Bonded Through National Notary Assn. .. f '�i�`. 'S- is � VN 5.}M%x S i F '9 a j� ry 51 LUCIE U.T;ILITIES-AP 2309 UIRBIHA AUE S T ,LUCYE COUNTY UTILITIES - P:O.: B�- -- 28 'FT.'`PIEItCE FL 34982 M; FL 34982 TERMINAL ID `003854111 1 d NAMEr' MERCHANT HP 4251fi2443997 KC i oxxxxxxxxxxxx2897 i ACC-,T-wl#y SALE p SERVICE ADDRESS 5A, BATCH' 680693 IHUOICE.' 693077 1ATE 'AUB 071 13 TIME• 10:31 t 89 .092: _. AUTH NO' 0070O2 SUBDIVISION LOT BLOCK TOTAL $ e22. 06 f BILLING ADDRESS CUSTOMER COPN t amount `Paid'; b22 . Uu PHONE # �i '_ INTONE IN/CLOSING DATE ;hangs Due: 0.00 This apphcatjon hereby request and authorizes the Utility to render water and/or sewage disposal frank YOU services #o the premises described above .in accordance with the Utilities present or futdre rates, rules andyregulatons, which by reference ate made;a part of this contract Applicantagrees to pay =a Utility promptly for such services m accordance with he estabhshedcules and regulations .' Jser ID: RODRIGUEZM E gthe RS DEPOSITS ARE NON OTIABLE OR'TRANSFERABLE CUSTOMENEG 1. = ! tE SOCIAL SEC/� { , FED- D SPOUSE SOCIAL SEC s _..p_3 !. .r. .....,..., {.: ... ...... ....-....+.......� .._., .. _�.. r .�Z .4":➢ ^VT