HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE 54MECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work. There is a$50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor. There is a$50.00 fee for the Change of Sub-Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: P - )- 1 7. Permit Number: 17 QS,;2-^
Site Address: 17_<e ice%
State License SLC License �J �-
Original GC,subcontractor or owner/builder
State License SLC License
New GC, subcontractor or owneribuilder hh ll S c /� p
Reason for Cancellation ��7/ r�r___1 i� /uw �l
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subconoaqtor or ryancellati of permit. A permit cannot be cancelled if work has been performed.
AA-tv�C
SIGNATURE OF OWNER(or owner/builder) V SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME rn (L' 4> Nbe_Q C/t✓� PRINTNAME
State of Florida,County of St Lucie County State of Florida,County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
1 day of —DeQ,.20A by �da�of 20_,by
who isDersonallv known to me �j 1 who is personally known to
or who has produced qk Ct r * . me or who has produced as ID.
Signature of Nota Date U Signature of Notary Date
a" r AUDREYB.HUMPHREY
o �s
Revised 05/18/2017 MYCOMtvlISSfUN#FF 174772
?a EXPIRES:March 6,2019
Bonded Thru Notary Public Underwriters
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 9 r�
Date: Permit Number:
0 . 0 e,
Building Permit Application
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 l
PERMIT APPLICATION FOR: ��
Address: �v' _ � r
Legal Description:
Property Tax ID#: )-/ -701 nin oco Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
4,1
ION M
Additional work to be pertormed 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 Construction: Sq. Ft. of First Floor:
Cost of Construction: $ GNU Utilities: —Sewer —Septic Building Height:
Name ! 1 IC Name:
Address: 12--&' (Vtte7--u ('h<<'[Sit1V-A Cr Company:
City: State:A-_ Address:
Zip Code: U Fax: - City: State:
Phone No. rb/ - f31,9 - 39 to 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.
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIO
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,
accessory structures,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
bfore the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co encin work or recording your Notice of Commencement.
Signature 6f Ownerl Lessee/Contractor as A r Own Sid ature of Contractor/License Holder
LU
rr
STATE OF FLORIDA ' T v TE OF FLORIDA
COUNTY OF ` ==> ' a NTY OF
The forgoing instru nt was acknowledged before me Q forgoing instrument was acknowledged before me
this J_day of 20_aby a 4i day of 20_ by
ices. m
Name of person making statement. Nva a of person making statement.
Personally Kno OR Produced Identificatio onally Known OR Produced Identification
Type of Ide ificatio / Type of Identification
Produced ! �l C Produced
(Signature of Not ublic-State of Flor' a ) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
Planning&Development Services Department
COUNTY Building&Code Regulations
as 2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
OWNER/BUILDER 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 is ble
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 handl
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 or 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 mei I
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 understaQd the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder a tion shall be reported by the Building and
Zoning Depart ent to the Florida State Department of Professional Re ulation. i ed and acknowledged n this
day o C of 20'T.
caner ilder Signature
STATE OF FLORIDA ,
COUNTY OF
The foregoing'nstrument was ac nowledged before me this ` day of D/ eC 20—LZ
by o is personally known to me,or who has
produced as identification.
OA A- N-_C� 44 rn�U,66r_/
Signature of N y Type Print Name of Notary / (Seal)
Title:Notary lic Commission Number
SLCPDSD Revised 05/15/2014
1 '
UA EV d.HUMPHREY
"""e` ti1V COMP 11SSION#FF 17477
N. += March 6,2019
'. nvr'ders
EXPIRES: PubricunO
°= nru Notary
Bonded 7