HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: REQ""°E IVES D
DEC 2 2 2016
•< PERMITTING
,.
Budding Permit Application St. Lucie County, FL
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:
Address: E SIS R t�G �2 c £ L tI
Legal Description:
Property Tax ID#: 3Lj0 3 ��, " G L�. – G SQ '" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
goo t,._
Additional work to be pertormed under this permit—c eck all that appy:
Mechanical _Gas Tank Y Gas Piping —Shutters _Windows/Doors
r Electric _Plumbing __Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 110.00 Utilities: —Sewer _Septic Building Height:
Name SSP,;::)c u C'x Le.,J Name:
Address: Nb Company:
City: iL {�6 sZ C �-- State: Address:
Zip Code: '3 L(J Fax: City: State:
Phone No. ���" '3—70— Zip Code: Fax:
E-Mail: 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.
- _ II IIII, I��iill II II III
II Planning&Development Services Department
Building&Code Regulations
2388 Virgiah RE C E I V E D Aveaoe tit
Fort Pierce,Florida 34982
`M)"2-150 DEC 2 2 2016
OWNERMUILDER AFFIDAVIT DISCLOSURE STATEMENT PERMITTING
F.S.489.103(7)EXEMPTIONS St. 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 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 applicable
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
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 liable 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 related medical
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 and acknowledRedon this
c _day if of 20 J1,n �-- ---
Owner/Builder-Signature
STATE OF FLORIDID A,
COUNTY OF I le I _
The fa egoing instrumentvv�acknowledged before me this day of 20f ZP ,
by �(' 1 n.K (e)(1 Z who is personally known to me,or who has
produced as identification.
1
Signature of Notary Type or Pri t N e of Na ,\"4Y'P (S E N S. N I E L S E N
Title:Notary Public Commission Number ; Commission # FF 115637
dr` My Commission Expires
�'':'°�PF��•`` June 12, 2018
SLCPDSD Revised 05/152014 """""
This Document Prepared By and Return to:
Elizabeth Moran
ST LUCIE TITLE SERVICES, INC.
800 Virginia Ave. , Suite 47
Fort Pierce, FL 34982
ParceilD Number: 3403-502-0143-050/6
Warranty rranty Deed
This Indenture, Made this 22nd day of December 2016 A.D., Between
Dilausan Holdings, LLC, a Florida limited liability company
of the County of St. Lucie I State of Florida , grantor, and
Isaac B. Mucklow and Miranda B. Mucklow, husband and wife
whose address is: 4781 Jorgensen Road, Fort Pierce, FL 34981
Of the County of St. Lucie I State of Florida , grantees.
Witnesseth that the GRANTOR,for and in consideration of the sum of
------------------------TEN DOLLARS ($10)----------------------- DOLLARS,
and other good and valuable consideration to GRANTOR in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, has
granted,bargained and sold to the said GRANTEES and GRANTEES' heirs,successors and assigns forever, the following described land, situate,
lying and being in the County of St. Lucie State of Florida to wit:
South half (South 1/2) of the. South half (South 1/2) of Lot 80,
Section 5, Township 36 South, Range 40 East, Sheen' s Map, White City
Subdivision, according to the map or plat thereof, as recorded in
Plat Book 1, Page (s) 23, of the Public Records of St. Lucie County,
Florida, less therefrom the East 20 feet.
and the grantor does hereby fully warrant the title to said land, and will defend the same against lawful claims of all persons whomsoever
In Witness Whereof, the grantor has hereunto set its hand and seal the day and year first above written.
Signed,sealed and delivered in our presence:
Dilausan Holdings, LLC, a Florida
limited liability company
By: (Seal)
Prined N -: �-_'
Sameriih G. Razuman, Managing Member
Wi tnei P.O.Address:2000 Hartman Drive,Fort Pierce,FL 34987
�A A
P — )i
rinte Name:n-- ->c
I
Witness
STATE OF Florida
COUNTY OF St. Lucie 2S <��
The roregoing instrument was acknowledged bere day of December 2016 by
Samerah G. Razuman, Managing Member of Dilausan Holdings, LLC, a Florida
limited liability company
who is personally known to me or who has produced her Florida driver's cense as identification.
rtf-M
ELIZABETH MORAN
My COMMISSION#FF 955951 d N�
Prin ed Nam
1_ :
EXPIRES:March 6,2024 Pu
Bonded Thfu Notary Public Undewritefs Nota Public
zcoMy Cormnissio xpires:
17120 Laser Generated by 0 Display Systems,Ine-2016 (863)763-5555 Form FlWD-1