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Home My WebLink AboutOwner Builder Affidavit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: e�• �• i0 Permit Number: y `T� RECEIVE® iY 4. Building Permit Application OCT 14 2016 Planning and Development Services 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: PRC3POSED INPRC}VEMENT LOCA-TION r ... i Address: &407- Rug- l- Legal Description: Property Tax ID#: Lot No%/3-4-l Site Plan Name: ,,/-� Block No. Project Name 1<00 Setbacks Front Back: Right Side: Left Side: DEl'AIi.ED DESCRIPTION aF WORK �^ n Y.I CO:NSTR UCTIC3N )NFOR_f1%IATION Additionalworkto e a orme d- p under this permit check .,...r. p pall that apply: _Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors ZVI/ Electric _Plumbing _Sprinklers _Generator _vRoof Pitch Total Sq. Ft of Construction: �oo Sg,7A_ Sq. Ft. of First Floor: Cost of Construction: $ OCA Utilities: _Sewer _Septic Building Height: r; OUIfNER/LESSEE COIV ,f r Name Name: Address: e_1f Company: City: -4-4 AY--re State: Address: Zip Code: y S Fax: City: State: Phone N.27o1) AC x-p -0 1 C7 0 Zip Code: Fax: E-Mail: RdvLt• ,,1 ( 10 OeCgo 1-J c7-�h�lwJ 1 hone 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. SUPPLEMENTAL CONSTRUCTION LIEN LAIN OR- DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: 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. I 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, accessorystructures,swimming pools,fences,walls,signs,screen rooms 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 comme cin work or-recording our Notice of Commencement. dl Signature of wrier/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFs �/ C COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this "t Ct day of C'C+ 20L-Coby this day of 20_ by (Name of person acknowledging) dr4 NNNI (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known Personally Known OR Produced Identification Type of Identification ==a`'�..rF= I Type of Identification YP :*: MY COMMISSION N PF 912389 Produced .: s EXPIRES:NovembAr 15,2019 Produced '.,,qf h.•' Bonded Thru Notary Publle 1Jnde(Wdta/3 Commission No. ea Commission No. (Sealr REVIEWS FRONT ZONING SUPERVISOR PLANS VENATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED / DATE COMPLETED ev.7/2014 --..........; lii ® Planning&Development Services Department Building&Code Regulations a 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT F.S.489.103(7)EXEMPTIONS State Iaw 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 allpI* 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 how to meet the minimum code. Initial P 44 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 (2 _— 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 for the cost of the license. Initial R— 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 medical cost,which could include loss of wages during recovery from their injury. Initial—124 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 Dep nt to the Florida St t Department of Professional Regulation. Signed and acknowledged on this day of of 20�. OwnerBuilder i ature STATE OF FLORIDA COUNTY OF The fo going instrument was a awledged before me this day of - ,20_; by F who is personally known to me,or who has produced as identification. Signature of Yoary T or Print Name of Notary (Seal) Title:Notary Mblic Commission Number SLCPDSD Revised 05/15/2014 pUDREY&HUMPHREY t r'Y MY COMM Math 6,20 92 E IRE ess '= NotarypublicUndervmt .+%�ftf fik' Bonded Thnw