HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: /Z- LO 16 Permit Number: Lo�''-+1
RECEIVED
111111111110 Building Permit Application D`c 2 " 216
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County. ,-L
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR:
Address: _ 7 a/ eff T11 .4 !7/G tY
Legal Description:
Property Tax ID#: 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L'7�2��� C„�¢c7' �ta►c+ C�� .�JY SQA-l�C� IQ y /�%C di/��ilP� !_d�,Q- c•f C
rZ�e, 441r7-,1122�Ff��,or.��1.
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructio Sq. Ft.of First Floor:
f0,my
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
Name '?A;1-4 /77AellA/ Name:
Address: 7Zv3 6,1A4..s Zk, $/ddr Company:
City: APS fi`C%Il State: /---/ Address:
Zip Code: 1rf�l Fax: City: State:
Phone No. 77 Z- Zj6 -/Z4 / Zip Code: Fax:
E-Mail: mciRiiN 0— A 7_1 , Ile� Phone No
Fill in fee simple 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.
iPlanning&Development Services DepartmenRECEIVED
UNTY Building&Code Regulations
2300 Virginia Avenue
Fort Pierce,Florida 34982 DEC 2 8 2016
(772)462-1553
PERMITTING
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT St. Lucie Count;, F.
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 plicable
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 PN
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 �N
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. Signed and acknowledged on this
day of 77G` of 20
OwneAuilder Signature
STATE OF FLOFJPA
COUNTY OF tA. UU
The foregoing instrument was acknowledged before me this 22 day of ,201 ,
bY��t�jO � 1r �jnl who is personally known to me,or who has
produced T aslidentification.
KAREN S. NIELSEN
Signature of o Type or Print Name of Notary eabommission t{ FF 115637
Title:Notary Public Commission Number ED it My Commission Expires
June 12, 2018
SLCPDSD Revised 05/15/2014