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Home My WebLink AboutBuilding Permit Application All APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ Date: Permit Number: ,Y t{��'II*,�q� CNE`r.. •.G.. r �E\^.� � I 11P Building Permit Application MAR 3 12016 Planning and Development Services PEWV11Trl,',JG Building and Code Regulation Division 5t. Lucie Cou , FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: .t:` ^�. Legal Description: Property Tax ID#: Lot No. Site Plan Name: _Q LJ /�'`�Q- O Block No.'' Project Name: Setbacks Front Back: Right Side: Left Side: �D,E�T�AfLEC► DESCR)PT(ON�OF�I�UORK�� . �k� � � �� r � � �� '� � � �`� c� f� lo(�-✓ c9� 'N-i , zCON5TR:UGTI(7N INF=ORMAT�ON � �� ,� Additional work to be performed under this permit–check all tat appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Q� Utilities: —Sewer —Septic Building Height: 3 � S Name kb Aok Name: Address: Company: City: t State Address: Zip Code: Fax: ' r City: State: Phone No. a Zip Code: Fax: E-Mail: ' CLI) Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. e''�skrF, t ",..rF'�*,°sem`^': .; •},zs '" 'r r - "*e^ xn ;iyl,s. ,,, �, z se's ; a r ` 'k a 3i 3„ y+, .uF j �x m �. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association'and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that,I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. The.following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screenrooms and accessory uses to another non-residential use WARNING 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 lender or an attorney before commenc,ing work or recording our , o ' e of Commencement. � 1 � Signature of Owner/Lessee/Contractor as A nt for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTYOF . l)(�,1� COUNTY OF The f rgoing instrument wa acknowledged before me The forgoing instrument was acknowledged before me this ( day of M10 m 20 by this day of ,20_ by �LL - (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification •fication Produced �•ls >aY°pan,, KAREN. S. XF Fc�� 'OM1 _ Commisson563 My CornrnisE ion Expires Commission No. June 7 ,CEC"glissio o. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014 Planning&Development Services Department { Building&Code Regulations o - 2300 Virginia Avenue Fart 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 for your use and occupancy. You may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own use or occupancy.You may not build or improve said structures for the purposes of selling or leasing that building. If you sell or lease a building you have built or improved within one year after construction is complete, then a presumption is created that it was built or improved 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. Your construction must comply with all a licable laws,ordinances,building codes,and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on howp,meet 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 and li 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 relat d}nedical 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 fiuther understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and Toning Department tote Florida State Department of Professional Regulati . Sig and acknowledged on s day of of 20 . OwnerBuilder Signature STATE OF FLORI . COUNTY OF D1 W C i t� ` It The for ping in trument was acknowledged before me this S day of '20'_1 to by 1 c� , ►41 who is personally known to me,or who has produced YJ. as identification. J AA Signature ofNotary Type or Print Name of Notarry (Seal) Title:Notary Public Commission Number �l �� ! SLCPDSD Revised 05/15/2014 ll"""++., KAREN S. N I E L 5 E N ��`�1g4Y PSB�t/'•i Commission# FF 115637 °° *= M y Commission Expires ��,~. June 12, 201 8 . ,t Ittiiitllll I SQ