HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Dile: Recei t# Pel-mit #
St. Lucie County Building & Zoning S
2300 Virginia Avenue Ft. Pierce, FL 34992-5652 N/V
%OR1Dp Tel. 561-462-1553 St `4C e% F�
SPECIALTY PERMIT APPLICATION e CoU0ry
❑ Electrical. Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and
:additional paperwork required, for specialty permits
I. Location/Site Address: 14 r71 ��1,(ii�-1 ��I�IJ� �� —► 1�%�- f" � 3��a�
2. Parcel ID Number: 3409, CD 0 O - D/ 0/ — coo 7
Office Use
Section
Township
Range
I Map Page
oning
Land Use
Initials
Only
4. Owners nformation S. Contractors Information
Name: " �f� (�r FL Reg/Cert #:
Address: g/ (j(t County Cert4:
City: V"T PUICL usiness Name:
Zip: 3q q b ry ,� �� hone: 4 &I—q6ohone
Od
6. Value of Construction: $ C�bd
Fax
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.
a e n e-z a (a J am°- C�, 4i
PRINT QUALIFIERS/OWNERS NAME - SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFOI:E ME "MIS DAY OF
20�, BY� n,`� �( _ G lur I IS PERSONALLY KNOWN TO ME OR WFIO HAS PRODUCED
ENI'IFICATION.
MY COMNN N`W 86E687
ATURI,OPNOTAR TYP13Oft PRINTNAM H. OF NOTARY =: EXPIRES: Memph22,2013
ar- . 5onded Tntu PO* UWP AN
TITLE: NOTARY PUBLIC COMMISSION NUN,1111-R
St. Lucie County Specialty Permit Application rev. 8/25/05 dmfi
- Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 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 applic le 1 ws,
ordinances, building codes, and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on htopeet
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. InitialR, (2,
1 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 lia a for the
cost of the license. Initial
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 me 'cal
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
M:7
ent to the Florida State Department of Professional Regulation. Signed and acknowledged on this
of 20 4L.
Owner/Builder Signature If
STATE OF FLORID
COUNTY OF
The foregoing instrument wacknowled
by r, 0n 0 U a a �.lr.rk
Signature of Notary
Title: Notary Public
SLCPDSD Revised 07/22/2010
before me this day of %20_1 /—,
who is personally kno tome, or who has
as identific ion.
Type or Print Name of Notary
Commission Number
(S@A1Nf I MILONE
MY COMMISSION # DID 852581
EXPIRES: Woh 22, 2013
Bonded Thru Nmtsry pyblis underwriters
OMM
WATER
_ SEWER
RES
_ METER SZ.
M/F
�`'
IRR
DEP
SECURITY
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
D Cr�
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
r _
TOTAL
)MER �y
? OF SPOUSE
DATE RECEIVED
5T. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. PIERCE FL 34982
NAME
ACCT. #
SERVICE ADDRESS
/Oleo
SUBDIVISION - � LOT BLOCK
BILLING ADDRESS `7 ��
PHONE # / 7<9'/LP /" L�&� 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/
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
CASH CHK #_ RECEIVED BY
Property Appraiser - St.Lucie Couni L
Page 1 of 1
PROPERTY RECORD CARD
Geneva G Clark
Record: 1 of 1
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Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
Site Address:
4715 SUNSET BV
ParcellD:
3402-608-0101-000-7 \��VUCIE��v2
Sec/Town/Range:
02 :36S :40E
Account: 37222
Map ID:
34/02N
Land Use:
SF Res
Zoning:
RS-4
City/Cnty:
St Lucie County
Ownership and Mailing
Legal Description
Owner:
Geneva G Clark
INDIAN RIVER ESTATES -UNIT 07- BLK 40 LOT 26 (OR 959-286)
Address:
4715 Sunset Blvd
Fort Pierce FL 34982-7135
Sales Information
Assessment 2010 Final Total Land and Building
Date
Price Code Deed
Book/Page
2010 Final: 47100 Land Value: 13000 Acres: 0.29
5/31 /1995
52000 01 WD
0959 / 0286
Assessed: 43456 Building Value: 34100
11/1/1985
42000 00 CV
0483 / 1626
Ag.Credit: 0 Finished Area: 945 SgFt
1/1/1983
0 01 CV
0391 / 0254
Exempt: 43456
11/1/1979
34500 00 CV
0321 / 0104
Taxable: 0
6/1/1978
28500 00 CV
0288 / 2032
Taxes: 213.1
BUILDING INFORMATION
Exterior Features
View:
RoofCover:
SD - Dim Shingle
RoofStruct:
GA - Gable
ExtType:
HC- - HC-
YearBlt:
1975
Frame:
Grade:
C- - C-
EffYrBlt:
1985
PrimeWall:
VS - Vinyl Siding
StoryHght:
0010 - 1 Story
No.Units:
1
SecWall:
Interior Features
BedRooms:
2
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
1
HeatType:
FHA - FrcdHotAir
AvgHUFI:
1/26ath:
1
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
FEN4 - CHAINLINK 4'
Y 1
180 AV AV
1975 1 0100-SF Res
BCS -Front Ft
100
DWC - Ddv-Concret Y 1 500 AV AV 1975
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
Depth
125
hIfn-//xvvvw.naslc_nrg/me_asn?ni-clid=340260801010007 7/20/2011