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Home My WebLink AboutSUBMITTED PAPERSDate: Fee Due: Receipt# Y `7 I Permit # IN / v c>-SA x°y St. Lucie County Building & Zoning S C /Vr 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 /v: o Tel. 561-462-1553Rk St Cj� �� eY `t SPECIALTY PERMIT APPLICATION count,, ❑ Electrical !'Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2. Parcel ID Number: -3q(2,2 - i/,o r W& � - OfficeUse• • :r��:. i7.SiLSL'li;i ii►ii:9 3. Description of Projector Work Activity:. - . r i I I- _ 4. Owners I form/atio 5. Contractors Information Name: �� 0 0� C- Reg/Cert #: (� Address: 54o Ip Paj;,J� County Cert#: City: P6 ai i�l� S ate: Business Name: �(,pG�na- Zip: �,)- Phone: ?Phone_ 00 6. Value of Construction: S 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. Ik J►'t A 2 I� G ace �,/z t c t� r PRINT QUALIFIERS/OWNERS NAME SIGNATURE- OF QUALIFII-R/OWNER STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED I3GFOP.G ME "I'IIIS / TDAY OF 20 BY _ MQ f tt 7� IT IhS P iRSONALLY KNOWN TO Mr Olt WI-10 I [AS PRODUCED TINCA lue � � DAWN MIL ONE SIGNATURL'OFNO'I'Alt 1'YPI:ORt'RIN'I'NAMIi01' MYCOMMISSION8DD852587 TITLE: NOTARY PUBLIC COMMISSION NUMBER ;; . = EXPIRES: March 22, 2013 pI ,.•ounded Thru Notary Public Underwriters St. Lucie County Specialty Permit Application rcv. 8/25/05 cling St. Lucie County Building & Zoning Department 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. Initial M 67 I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. Initial M Z;— 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 M 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 liable fppr the cost of the license. Initial My 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 �edical cost, which could include loss of wages during recovery from their injury. Initial jn, 7; 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 Zon g Depart ent to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20 �. Owner/Builder Signature STATE OF FLORIDA _ COUNTY OF /Q The foregoin instr�nt s acknowledged before me this -r day of by i 6 Oo C� r t who is personally known to me, or who has diced as identification. .�DAWN MILONE Signature of Notary Type or Print Name of Notary ' MY COMMISSION # DD 852587 Title: Notary Public Commission Number y •:= EXPIRES: March 22, 2013 D)nded Thru Notary Public Underwriters St. Lucie County - PCIS 01-18-2011 10:38:34 10968/4703 GOODRICH, MARK 5406 PALMETTO DR FORT PIERCE FL 34982 Amount Tendered: 470.00 )unt Paid: 470.00 unanse Due: 0.00 Thank You User ID: WARDD l / A. LAI'EkAL $ 77U �) TOTAL CUSTOMER SIGNATURE NAME OF SPOUSE ACCT. # SERVICE ADDRESS f'_-4— SUBDIVISION (, t LOT .3 BLOCK BILLING ADDRESS PHONE # 77.) , 2 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 DATE RECEIVED / / �► / CASH CHK # ! .% RECEIVED BY Property Appraiser - St.Lucie County. FL Page I of I PROPERTY RECORD CARD Mark L Goodrich Record: 1 of 1 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification Site Address: 5406 PALMETTO DR ,�LUCIECD ParcellD: 3402-606-0062-000-5 G;�' Sec/Town/Range: 11 :36S :40E Account 9: 36906 �1*— Map ID: 34/11 N Land Use: SF Res Zoning: RS-3 City/Cnty: St Lucie County Ownership and Mailing Legal Description Owner: Mark L Goodrich Debra A Goodrich INDIAN RIVER ESTATES -UNIT 05-BLK 22 LOT 3 AND INDIAN RIVER Address. 5406 Palmetto Dr ESTATES -UNIT 06-BLK 22 LOT 4 (MAP 34/11 N) Fort Pierce FL 34982-7444 More... Sales Information Assessment 2010 Final Total Land and Building Date Price Code Deed Book/Page 2010 Final: 110100 Land Value: 29700 Acres: 0.91 7/31/1997 96300 00 WD 1091 / 0803 Assessed: 108886 Building Value: 80400 2/1/1985 13700 02 CV 0457 / 1382 Ag.Credit: 0 Finished Area: 1849 SgFt Exempt: 50000 Taxable: 58886 Taxes: 1428.32 BUILDING INFORMATION Exterior Features View: RoofCover: FS - Fibrglss Shg RoofStruct: GA - Gable ExtType: HC- - HC- YearBlt: 1987 Frame: Grade: C- - C- EffYrBlt: 1987 PrimeWall: BS - CB Stucco StoryHght: 0010 - 1 Story No.Units: 1 SecWall: Interior Features BedRooms: 3 Electric: MX - MAXIMUM PrmintWall: DW - Drywall FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/Fl: 1/213ath: 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 Qua[. Cond. YrBIt. No. Land Use Type Measure Depth DWC - Driv-Concret Y 1 720 AV AV 1987 1 0100-SF Res BI -Front Ft 132 300 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED http://www.paslc.org/prc.asp?prcIId=340260600620005 l /18/2011 Property Appraiser - St.Lucie County_ F1, Page I of I PROPERTY RECORD CARD Mark L Goodrich Record: 1 of 1 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification ,\�,�CIE co. Site Address, 5406 PALMETTO DR ParcellD: 3402-606-0062-000-5 2� Sec/Town/Range 11:36S A0E Account# 36906 �� Map ID: 34/11 N RS-3 RS-3 Land Use CitylCnty SF Res St Lucie County �'• ; - Zoning. Ownership and Mailing Legal Description i.� Owner: Mark L Goodric INDIAN RIVER ESTATES -UNIT 05-BLK 22 LOT 3 AND INDIAN RIVER Address: 5406 Palmetto Dr _ ` ` ESTATES -UNIT 06-BLK 22 LOT 4 (MAP 34/11 N) Fort Pierce FL 34982-7444 More... Sales Information Assessment 2010 Final Total Land and Building Date Price Code Deed Book/Page 2010 Final: 110100 Land Value 29700 Acres 0.91 7/31/1997 96300 00 WD 1091 / 0803 Assessed: 108886 Building Value 80400 2/1/1985 13700 02 CV 0457 / 1382 Ag.Credit 0 Finished Area 1849 SgFt Exempt: 50000 Taxable 58886 Taxes 1428.32 BUILDING INFORMATION Exterior Features View. RoofCover: FS - Fibrglss Shg RoofStruct: GA - Gable ExtType HC- - HC- YearBIL 1987 Frame Grade: C- - C- EffYrBlt: 1987 PnmeWalt BS - CB Stucco StoryHght: 0010 - 1 Story No.Units: 1 SecWall Interior Features BedRooms 3 Electric: MX - MAXIMUM PrmintWall: DW - Drywall FullBath 2 HeatType: FHA - FrcdHotAir AvgHUFI: 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 Oual Cond YrBlt No Land Use Type DWC - Driv-Concret Y 1 720 AV AV 1987 1 0100-SF Res BI -Front Ft 132 300 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED http://www.paslc.org/prc.asp?prclld=340260600620005 1 / 18/2011