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Home My WebLink AboutSUBMITTED PAPERS�1 Planning & Development Services Building & Code Regulations Division SQANNIIo 2300 Virginia Ave. St BY Fort Pierce, FL 34982 uCie COUt1 ty (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC PiFence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: w) E, scoTT S7-Q,2iT- fa/-7- A/elleZ IC( 3y9S2- 2. Parcel EDNumber:Ez O-D, Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Complete Description of Project or Work: A j1 P 1 r J0 4/ o i— t1 S ! /7ty m f/ T 0i -'17 (211-6 /A.) G l V /C F ff Ve-.e 7-0 ry 9 S i S O e Yo, ! ,) L',04 Gd S/ d%6 `/" P 1-0 ,v 6 P AO- 0 4F2 7- Y L-/ x)g 1 3 Foote F6A)c8 9- 7 400r VIDE CA E 4. Owners Information 5. Contractors rm n Name: W i /I aMl �tr17 er�nCL-0—� �P� e� l Address: Q dtd fz-7 S C d T7T 5 7-A h h 1— County Cert#: City: �L ,d / State: Business Name: Zip: 3 L/fg Z Phone: p2-SO7,! Phone: 6. Value of Construction: $ 6� � 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- tr n (t)l 11/Qll 31—i -1,Wt39et &A) PRINT OWNER OR CONTRACTOR NAME F R OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ck-E!— , ACKNOWLEDGED BEFORE ME THIS �_ DAY OF 20 S BY \ \` ��O 1 ' �► WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION. z_ A?y AN�F M xa 5 �V40 M. -� •• �a��r 1pN�oes SIG OF N ARY TYPE OR PRINT AME OF NOTARY bti NO�ryP�b�� d016 5 e COMMISSION NUMBER 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 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 respnnsibilit; 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 wit a -app i- - — ,- - ordinances, building codes, and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on ho 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 andAlia ;Y?!e cost of the license. Initia 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 z 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 Zo Department to th Florida State Department of Professional Regulation. i ed and acknowledged on this day of Gi of 20 L. - e /B ' er8 gnature STATE OF FLORIDA COUNTY OF � (—. � day 20_a The foregoing n}strument was knowledge before me this of `T known to has by sfpersonally me, or who produced 1 ''dentifi1clation. n Signature of otary Type or Print ame of Notary Title: Notary ublic Commission Number al�` ..•. 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