HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: �' Ito Permit Number: 1 l
04-
R E C[F.9 I f
• APR 0 8 2016
b �
Building Permit Application PEWMTTING
Lucie County,Planning and Development Services St. FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: s V)
PROPOSED,INPROVEMENT LOCATION:
Address: 1� kJ V_19 e; t^ y �o r( I Fit �� 3 I q i--,-
Legal
l/Legal Description:
Property Tax ID#: 233 ' �(��j �d�JO f ��Do/Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
(a LA)
CONSTRUCTION INFORMATION: -
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _,,flumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
�n r�. '
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE ,`CONTRACTOR
Name �1)q-m o IVY Name: P i 7Z-�A)(a) I� ya'M
Address: J&PI .Sv A4ZI S ✓p Company:
City: ff, iie-p-Cr, State:11:�' Address:
Zip Code: Fax: 1'71- City: State:
Phone No. 17 '12- 1 Io ' 1 ) Zip Code: Fax:
E-Mail: b2J1siPJJaH, i)9-1 Phone No '7-7y' 014 `t
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.
Planning&Development Services Departmeif-
Building&Code Regulations E '
o 2300 Virginia Avenue
Fort Pierce,Florida 34982 APR
0 �o>�
(772)462-1553 A
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT PEW-AITTING
F.S.489.103(7)EXEMPTIONS Si. Lucie County, FL
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 itis 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 ap able
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 howO meet
the minimum code. Initial—
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be ha dled
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 liable he
cost of the license. Initial 141
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 relatedeical
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
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
Ph day of A& 1 L of 20�.
(k `
O rer/Builder Signature
STATE OF FLO A
COUNTY OF
The foregoing instrpment was acknowledged before me this day of 7L V1 20(,
by who is personally known to me,or who has
produ ed L LIP as identification.
Signature of Notary Type or Print Name of Notar (Seal)
Title:Notary Public Commission Number l
SLCPDSD Revised 05/15/2014 = KAREN S. N I E L S E N
�'= Commission# FF 115637
�C *-
- o`? My Commission Expires
June 12, 2018
Customer Copy
Fort Pierce Utilities
206 South 6th Street
Fort Pierce, FL 34950 :' '•
(772) 466-1600
Phone(772)466-1600
Fax (772)461-1938
Date: 29-MAR-2016
Time: 02:19:09 PM ERINVOICE<(sESTIM�ATE.ONLY) `. � i 3
Invoice:
�
10006862-246165 LABi�
'S
1 iro „ �? y r ''•fit. £�Z t` "
Card Typ x b t x7
e: Mastercard I TE'FOR tJ'AMESAPOUNQS 4t ass
Card Number: XXXX3607
Trans ID: 8113697649 LL NEW 5/8rx3/41NAtERMETER PkUSSERYIOEc � F a i r 1
Auth Code: ' 009235
.-
; Approved Amt: $1820.50 PREPARED BY: WARE
'IERCE FL USA 34982
I AGREE TO PAY THE ABOVE TOTAL allsouth.net
ACCORDING TO MY CARD ISSUER
AGREEMENT.
LI *
$800.00 $800.00
Budget Billing Now Available *** G 1
URGE $0.01 $920.50
)ST $0.01 $40.00
CUSTOMER COPY -JsT $0.01 $60.00
. $1,820.150-
Customers
1,820.50-Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater
Connection Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the
house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health
Department must be obtained prior to initiating a septic tank abandonment.Contact the Health Department at (772)873-4931.
Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at
the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse
weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the
customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the
customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority.All fees are due prior to any
construction.
Note: This is only an estimate. A bill will be provided following acceptance of the Customer Invoice once signed and dated. Please
submit accepted Customer Invoice to Customer Service at 206 South 6th Street, Ft. Pierce, FL 34950 or call (772)466-1600 to setup an
Customer Signature: Date:
Printed Name:
PAGE 1 OF 1 PRINTED ON: 03/29/2016 AT 02:09 PM=_,