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4
OFFICE USE ONL_ Y•r 1 -'{
DATE FILED:
PLAN REVIEW FEE, RECEIPT NO.: q2_ia_ PERMIT NUMBER: 1 5
CONCURRENCY FEE: RECEIPT NO.: CERT, CAP, NO.:
ALL INFO MUST BE COMPLETE & FILLET) IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 SCAiVMED
772-462-1553 Nl
St. Lucie, county (9)
APPLICATION for B U ILVIN G PERK'
CERTIFICATE ®f CAPACITY/ZONING COMPLIANCE �
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: d�(S�t� J-
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID
4, LEGAL DESCRIPTION (attach extra sheets if necessary):
Lam
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO,
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
10, COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: A14w AlTe-1 ierJ
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14.
16.
SQ. FT OF CONSTRUCTION:
15. SF. FT 1st FLOOR: 42107
IIA4- 4
VALUE OF CONSTRUCTION: $ ';2 OJ Opa
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures arc not consistent with similar types of construction activities. 1f the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25109
I�
t
OWNER V NER INFORMATION
NAME:�6�/
ADDRESS: O SS' /O e—e4� ,�� U G v�
CITY: .T<i�� A5gr '-" STATE: -ZIP;--
PHONE (DAYTIME): �2-� i�7�3 Email:
IF THE. FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): U
CONTRACTOR RNFORMATION
ST. of FL REG. CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): �)
ARCHIVENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): L__)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
FAX NO.
STATE:
STATE:
STATE:
ST. LUCIE COUNTY CERT #:
Email:
ZIP:
ZIP:
ZIP:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
CERTIFICATIONO- �-
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concur ency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLO A
COUNTYOF
The foregoinSnt
g instrument was acknowledged before
me this C day of t r�1 ^ 20 1
by Q � P.)C�Gde�t
who is personally known zor has produced
KJ_ _ as identification.
Signatu a of Notary
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this day of
by
20
who is personally known or has produced
Signature of Notary
ALEMS HULL
Commission No.9 9 1 q� Sedl n' NOTARY PUDLuC Commission No. (Seal)
STATE OF FLOMDA
' Explroo 3/4/2010
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR .TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
r i
as identification.
OFFICE USE ONLY
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
I sr FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
N6�
AREA
FEE
FEE
l v \
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
:FEE
CORRECTION
FEE
FEE
GENERAL
-SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
J
COMPLETED
INITIALS
i i
PLANNING & DIEVELOPM ENI-AERVIC ES DIVISION
BUILDING & CODE REGULATIONS (DIVISION
2300 Virginia Ave
Fort Pierce, FL 34982
]BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
will be using the following sub -contractors for the
(Company/Individual Name)
project located at /`fir-o LT Pe:ell4 e/(J ilewrew
(Street address or Property Tax ID #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning (Department of St. Lucie County.
Trade
(game -of Company/Contractor
Ste Lucie County/
State of Florida
License Number
Electrical
Plumbing
HVAC/
Meclnanicafl
(Roofing
Gas
PERMIT ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable):
x� - /���.�a`r have agreed to be the
(Company Name/Individual Name)
e_- sub -contractor for f�
(Type of Trade) (Primary Contractor)
for the project located at ,10 •
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL SIGNATURES AREREQUIRED
,4Q
IGNATURE PRINT NAME AT
Business Name:
Address:
City/State/Zip:
Phone:
OFFICE USE ONLY:
email:
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): CrC 3 3 S et ff
1 A L. have agreed to be the
Company Name/Individual N e)
V M sub -contractor for
(Type of Trade) (Primary Contractor)
for the project located at
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie Countybypersonally filing a Change of Contractor notice. o : S -
5-r, LV 0 1 C C'G lTr►TVj +a��ua MARGARET M. LEONARD '
` Q�41.RY P B�4i
No. 004-00) S`T-w�{ C►-� �L ;roe � `�-;, Notary Public -State of Florida
My Comm. Expires Jul 17, 2015
%� ;� P:= Commission JE EE 77881
�; �`° Bonded Through National Notary Assn.
BUSINESS QUA IFIER (Name of the Individual sh o ontra Tor's License)
ORIGINAL SIGNATURES ARE REQUIRED
Zee Rgo"'1a4 S /6
SIG A PRINT NAME D E
Business Name: T I
Address: A
City/State/Zip:
Phone: r
nVIWICF. IT.CF. (INT,V-
V11
PERMIT # ISSUE DATE
931 �Iq ,/, eo07
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 applica 1 ,
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 t eet
the minimum code. Initiate
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
Initi
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 f he
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 me i
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 owneribuilder exemption shall be reported by the Building and
Zoning Department to the Florida Stat Department of Professional Regulation. Signed and acknowledged on this
t day of of 20
Owner/Builder Signature
STATE OF FLORI
COUNTY OF, I -A ^..
The ego
ins ume was ackno edged before me this Zl day of 1 ' �-`^' 20 1
by who is personally known me, or who has
R ced as identification.
Signature of Notary Type or Pr—mTT,4ame of Notary .(Seal)
Title: Notts Public Commission Number ,1tiPpY Fia•, 1,.;, ' D�WN MILONE
?°• `� : Notary P•u lic - State of Florida
SLCPDSD Revised 07/22/2010 ►e MY Comm. Ex;Oes Mar 22, 20,17
°•• Commission # EE 877571
F lr"' Bonded Through g National Notary Assn.
Planning & Development Services Department
Building & Code Regulations Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-1553
Owner Builder Affidavit — Electrical Contracting
DISCLOSURE STATEMENT
F.S. 489.503 (6) EXEMPTIONS
State law requires electrical contracting to be done by licensed electrical 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
electrical contractor even though you do not have a license. You may install electrical wiring for a farm outbuilding
or a single-family or duplex residence. You may install electrical wiring in a commercial building the aggregate
construction costs of which are under $75,000. The home or building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease more than one building you have wired yourself within 1 year
after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your electrical contractor. Your construction shall be done
according to building codes and zoning regulations. 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. Failure to do so may result
in a liability for you!
To qualify for this exemption under this subsection, an owner must personally appear and sign the building
permit application.
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
Community Development Director to the Florida State Department of Professional Regulation. Signed and
acknowledged on this -2—,l— day of �M�t , 20/Y .
OWNER/BUILDER SIGNATURE
STATE OF FLOR
COUNTY OFF
The f766-p_
ing i�nstrument was acknowledged before me this ` day of , 20 B ,
by v' , who is personally known to me or
has produced L, V
Sig ure of Notary
Title: Notary Public
SLCPDSD Revised 7/23/2010
as identification.
Print name of Notary
4'Ry p" DAWN MILONE
i°, Notary Public - State of FkAda
Commission Number My Comm. Expires Mar 22, 2017
Os Commission N EE 077571
Bonded Through National Notary Assn.
St. Lucie County Owner Builder Affidavit -Electrical Contracting
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY
FILE # 3836487 OR BQJ,--'1i1520 PAGE 923, Recorded 05/21/2013 09:35 AM
Permit No.
State of Florida County of St. Lucie
NOTICE OF COMMENCEMENT
Tax Folio
The undersigned hereby gives notice that Improvementwill be made to certain real property, and In accordance with Chapter 713, Florida Statut
the following information Is provided In this Notice of Commencement.
Legal DRsrsl tfo of Pro erty: (an street addr ss If available):
�� �iQ„y dry A'.'*
of improvement:4666ri /47c%�
Owner informatio or Lessee information f the �,essee contracted for the improi
Name �Ep�o t .,v.
Address d O J LeC�.erw/ L t/ i s
Interest In property:
Name and address of fee simple titleholder (If different from Owner listed above):
Contractor's Name: 494&2r.112e
Contractor Address: Phone Number: V 71—E=X7
Surety (if applicable, a copy of the payment bond Is attached): Amount of bond: $
Name and address: Phone number.
Lender Name: Phone Number:
Lender's address:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
17 3.13(1)(a)7., Florida Statutes:
Name: Phone Number:
In addition to himself or herself, Owner designates of
Llenor's Notice as provided In Section 713.13(1)(b), Florida Statutes.
Phone number of person or entity designated by owner:
receive a copy of the
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the bests
my knowledge and belief.
y.+�
(Signature of Owner or Lessee, or Owner's or Lessee's Authorized Officer/Director/partner/Manager
(Signatory's Title/Office)
The foregoing instrument
By �
was acknowledged before me t
his'k day of 20L,
as eofauth�/Y for
n Type of authority (e.g.officer,trustee)
(Signatux of Notary Public • te of Flor ),,+;" %,, EDNA DANDRIDGE
(Print, Type, or Stamp Commissioned Na �M4�ry Public • State of Florida
y omm. Expires Aug 3. 2016
_ rr Commission I EE 167876
i t•' ,, Beaded Through NUIonal Notary Assn.
Party on behalf of whom Instrument was executle
onally known_or produced Identificatio
ntn v.
of Identification produced f (.' ioU' L--,
STATE OF FLORIDA
ST. LUCIE COUHTy
TNIS IS TO CERTIFY THAT THic it s
TRU�EAW ORRECTCOPyOF
ORfGI L
JO liAI CL RK
Deputy jerk
Date.; eMAY 9 1 hn
ST, LUCIE Coy
BUILDING DIVI-
RF.VlF.W9_
FOR 0
Ramwel) 13Y
DATE
PLANS AND
MUST BE KEPT 0
NO INSPECTION WIL
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