HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fce Due: Recei Permit #
St. Lucie Count Building & Zoning
SC
^ iiA 2300 Virginia Avenue Ft. Pierce, PL 34982-5652
ort P' Tel.561-462-1553`G eCOy F®
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SPECIALTY PERMIT APPLICATION Una
❑ Electrical. Plumbing ❑ H VAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
0A) Location/Site Address: (.(�®3 �uCACA -D-)
-2% ParceI ID Number:
Office Use
Section
I Township
Range
I Map Vage
I Zoning
I Land Use
ln' 'als
Only
Z
S
u
FA
cription of Project or Work Activity:.
Owners Information S. Contractors Information
Name: FL Reg/Cert #: .
Address: jplo 3yuC.CA County Cert#:
City: r 40 Q4 CQ_State- Business Name•
G 7�
Zip: 3 l �o� hone: bs' q %hone Fax _
6. Value of Construction: $ , I L o
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 QUALIFIERS/OWNERS NAME
ST E OF FLORIDA COU TY OF l
20/, BYY / V
C� V
SIGNATURI" OF NOTARY
TITLE: NOTARY PUBLIC
St. Lucic County Specialty Permit Application rev. 8/25/05 (ling
slG ATURr: or =uv11
KNOWLEDGED BEFORE ME THIS DAY OF
,Y KNOWN TO ME OR WFIO HAS PRODUCED
AS IDEN'TI 'I'ION.
TYPE Olt PRINTNAMI? (DAWN MILCNE
� 1'
COMMISSIONNUMIIER = ��YP1 's COMMI IpI� DD852iiv587
EXPIRES: March 22 2013
qF N' Bonded Thru Notary Public Underwriters
e
y Planning & Development Services Department
Q ` 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 applicable laws,
ordinances, building codes, and zoning regulations. Initia
I understand that the building official and inspectors are not there to design or give advice onihnoto meet
the minimum code. InitialI understand that as an owner -builder that any contract disputes with sub -contractors and I mundled
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 re d to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and lia 1 for the
cost of the license. Initial L
I understand that if any person that is unlicensed and uninsured gets injured on my construc • roject-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate edical
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 uilding
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 Depar ent to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of - of 20 ([
O r uil r9ign
STATE OF FLORIDA
COUNTY OF
4
The f oing instrument a owl d ed.>Z"fore me this -A—day of , 20�,
by s `(L� who is personally kno to me, or who has
duc as identification.
( -y°
1 ure of Notary Type or Print Name of Notary :� Se MMISSION a ri11 abz5g7 j j
' 9.... 0�nded PIKES: Marcy
Title: Notary Public Commission Number Thm %taryl'ont,r
SLCPDSD Revised 07/22/2010
WATER
COMM
SEWER RES
METER SZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
¢/
' i O (O • D
METER INSTALL.:
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
$ Y • ®
LATERAL
TOTAL
FL 3
NAME L&W C.j' ti—
ACCT. # J (J
SERVICE ADDRESS G(.
SUBDIVISION LOT ✓ BLOCK u /
-BILLING ADDRESS]
PIIQNE.# 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 NONNEGOTIABLE OR TRANSFERABLE.
`,CUSTOMER . SO,CIAL.SEC%3 -
�SIG NATUR *t,6" FED 'ID
NAME OF SP SPOUSE SOCIAL SEC.
-- Ol
OFFICE USE ONLY /,,
DATE RECEIVED CASH CHK # OU/ RECEIVED
1
Property Appraiser - St.Lucie Cr ^Ly, FL
Page IofI
PROPERTY RECORD CARD
Joann T Jefferson
Record: 1 of 1
<<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
�BCIE �
Site Address:
6103 Yucca Dr
ParcelID:
3402-610-0601-000-9
Sec/Town/Range:
12 :36S :40E
Account ": 38690 y� j
Map ID:
34/12S
Land Use:
SF Res Q,
Zoning:
RS-4
City/Cnty:
St Lucie County
Ownership and Mailing
Legal Description
Owner:
Joann T Jefferson
INDIAN RIVER ESTATES-UNIT-09- BLK 89 LOT 33 (MAP 34/12S) (OR
Address:
6103 Yucca Dr
692-888)
Fort Pierce FL 34982-3717
Sales Information
Assessment 2010 Final Total Land and Building
Date
Price Code
Deed
Book/Page
2010 Final: 71500 Land Value: 10400 Acres: 0.23
5/22/1990
100 01
WD
0692 / 0888
Assessed: 71500 Building Value: 61100
12/1/1986
65000 00
CV
0525 / 2906
Ag.Credit: 0 Finished Area: 1682 SgFt
10/1/1986
0 01
CV
0523 / 1892
Exempt: 46500
3/1/1986
0 01
CV
0501 / 2209
Taxable: 25000
8/1/1985
7000 00
CV
0477 / 1538
Taxes: 695.42
BUILDING INFORMATION
Exterior Features
View:
RoofCover:
SD - Dim Shingle
RoofStruct:
GA - Gable
ExtType:
HC- - HC-
YearBit:
1986
Frame:
Grade:
C- - C-
EfiYrBlt:
1986
PrimeWall:
CB - Cedar Bd/Btr
StoryFlght:
0010 - 1 Story
No.Units:
1
Sec1Nall:
Interior Features
BedRooms:
3
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/FI:
1/2Bath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CU - Carpet
%A/C:
100
%Heated:
100
%Sprinkled:
0
Special Features and
Yard Items
Land Information
Type
Y/S Qty.
Units Qual. Cond.
YrBlt. No. Land Use
Type
Measure
DWC - Driv-Concret
Y 1
720 AV AV
1986 1 0100-SF Res
215 -Front Ft
80
FEN4 - CHAINLINK 4' Y 1 180 AV AV 1989
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
Depth
125
1-ittp://www.pa.slc.org/prc.asp?prelid='D40261006010009 7/1/2011