HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
= - BUILDING & ZONING DIVISI RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 M A R 29 Ji8
(772) 462-1553 FAX 462-157
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAS ELECT 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 completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form.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. `"I06-4 49
Date: 2�1 Permit Number:
Site Address: �S 1 ?Idyo,
k \,d State License SLC License
Original GC,subcontractor or owner/builder
�W ht t \&,,a ,\C\-.f State License SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or dW3tlaiges g from any and all claims of action for any reason,which may arise as a result of this change of
contractor/ c ntrac r or cancellation of permit.A permit cannot be cancelled if work has been performed.
,M16NA13XEOF O ER(or own der ;V SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME S'} • NX% PRINT NAME
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
.2°i.day of Ch14 20_XA_by MA r day of .20_,by
Q Ao� `��,`1a'f� who is personally known to me who is personally known to
who has produced fly' as ID. me or who has produced as ID.
Signatu o� DINARIE GIVENS Signature of Notary Date
MY COMiAISSION#GG 022023
EXrs
EXPIRES:December 16,2020
Revise +l8� 80Notary Public Underwrite
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L) �V u Permit Number: `1 ws (3m
=Lucien9ty
•
Building Permit Applic
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:
A-
Address: [ Sc D`c 4 VL `
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
_ -
low
Additional work to be performed under this permit–c ec all that apply:
_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. $ 1J O a Utilities: —Sewer _Septic Building Height:
I
Name:
Address: At �� �V& � Company:
City: End S�. u LW-A'k— State:EL Address:
Zip Code: �j41�3 Fax: City: State:
Phone No. ( 56 1 (Jol' II ` Zip Code: Fax:
E-Mail: PVJ� W'45 grn9u� , �oM� 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -
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
before the first inspection. I ou intend to obtain financing, consult with lender or an attorney before
commencing work okrecor ing your Notice of Commencement.
Cf/�WA
Signature a essee/Contracto as Ag t Mr Own Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'S->* • L A) COUNTY OF
The forgoing instrument was acknowledge4 before me The forgoing instrument was acknowledged before me
this-4,4\ day of'1'-N AL . 20 VT by this day of 20_ by
Qom \ 1% -1 :!� 1J�&�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L- >D L^ Produced
<4 P DEANNA MARIE GIVENS
Commission No. MY COMM #GGo22023
sr. EXPIRES: 16,'LQ�O
Commission No. (Seal)
•op' Bonded Thru NamrY�uh�t°v•i,; ;ers
eOi Fes,.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 712014
RECEIVED
Planni g&Development Services Department
�1 p Building&Code Regulations
• • MAR 2 9 J1 J 2300 Virginia Avenue
Fort Pierce,Florida 34982
ST. Lucie County, Permitting (772)462-1553
OWNER/BUILDERAFFIDAVIT 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 cable
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 eet
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.
Initia 1
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 liabl o 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 al
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 owneribuilder exemption shall be reported by the Building and
aZ ntn Departn to th Florida State Department of Professional Regulation. Signed an acknowledged on this
�ay of of 20 AL.
er ilder SigrkUKe
STATE OF FLORIDA
COUNTY OF SV. . V V c t
The foregoing instrument was acknowledged before me thisQA day of tea►( ,20\ ,
by d-v 1 N',% 0-A who is personally known to me,or who has
produced `
DEANNAMARIEGIVENS
ALb rq G MY COMMISSION#GG 022023
�ignat�ureofot Type or Print Name o PI12ES:Dec Publik16 2020
•'':� onded Thru Notary Pu61i teK.
Title:Notary Public Commission Number
SLCPDSD Revised 05/15/2014
NOTICE OF COMMENCEMENT
Permit No. �1 G 'd y 1 Tax Folio No. fkA ,q� oo t1" 0 00-9
State of Florida County of St.Lucie
The undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement.
Legal Description of Proerty:(and street address if available):
S � r550 00 8 - o0'0 - 14
General description of improvement: RAW) Boa
Owner inform ssee i formation if he Lessee contracted for the improvement:
Name
I-i'V L
Address I )- u U
Interest in property:
Name and address of fee simple titleholder(if different from Owner listed above):
U �v
(J/�` � r1y W n8
Contractor's Name: i A v L N Gv p o�
Contractor Address:_a l !L G vc- Phone Number: 7 7 1 x �o
� oa
N
Surety(if applicable,a copy of the payment bond is attached):Amount of bond:$ z°' $
=7oao
Name and address: Phone number: c0i w
v�wm�t7
Lender Name: Phone Number: x�'$o
Lender's address: y Z W m o
oa. UJ
0�U 0E
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Sr
713.13(1)(a)7.,Florida Statutes:
Name: Phone Number:
Address:
In addition to himself or herself,Owner designates of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Phone number of person or entity designated by owner:
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor,but will be 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE 10B SITE BEFORE THE FIRST
INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declar at I ha d the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowledge and belief.
(Signature of Owner or Le e,or Owne Lessee' Author# d Officer/Director/Partner/Manager
(Signatory's Title/Office)
The foregoing instrument was acknowledged before me this aA day of d 20I
ByR d J n as 0 w in-a f for �L T o o('�� 0%z M-r
Name of Person officer,trustee) Party on behalf of whom instrument was executied
DEANNA MARIE GIVENS
"9 MY COMMISSION#GG 022023 Personally known—or produced Identification
(Signature of Notary blit State of ffi „? = EXPIRES:December 16,2020
. 1° 'BoWe Notary Public Underwriters T
(Print,Type,or Stamp Commissioned u��t) Type of Identification produced �-