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HomeMy WebLinkAboutChange of Contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J r. Date: f' Permit Number: EZ) AlunoD ai�nl •4S �aedad 6ui41iva.lad uilding Permit Appli Rin p E No 4 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 (13AI FA Phone: (772)462-1553 Fax: (772)462-1578 Commercial — PERMIT APPLICATION FOR: PRf'®SED GN+PROUEME'N1' L®C�►TIO'N: nI Mimi Address: �. s G Q,S I?-, r, V 4 o rT Si u c: F 3 S Legal Description: 't� Property Tax ID#: 7' �� ©� ��� y Lo t? • Lot No. T Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DET CQNSTRUCTlQ INFOR -ATI®N: 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 Construction: Sq Ft. of-First Floor: Cost of Construction:$ Utilities: Sewer _Septic Building Height: owN'ERJLE=.SSEE: ONTR+ CgTQR: Name 6 Gam_ . f c%t'C I l'i--ems Name:goe.:r- Fe in-a q-, h e- Address: s' (Fa les Nes)I- Wo'z Company: City:Pear -ST; L vci L State: Address: Zip Code:3 f yd".- Fax: City: State: Phone No. V/`/' `ISO -E7 ZO Zip Code: Fax: E-Mail: rr a i n e 66 a co , Go"i Phone No Fill in fee simple Tit a Holder on ne 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 C«®NSTEtUCTI®N LI> N 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 a's 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. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. XZ�W Signature of Owner/Lessee/Contr or as Agent for Owner Signature of Contractor/License Holder STATE OF FLORI STATE OF FLORIDA COUNTY OF COUNTY OF lXT", The fPrgoing instr ment wa acknowledge befor The forgoing instrument was acknowledged before me thi 0 day of 20� 'by '?� this day of_ 20 by p„t' — a (Name of person acknowledging) N� (Name of person acknowledging) � �gi v �'x o (Signature of N Public-State of Florida ) iN (Signature of Notary Public-State of Florida ) V1 Personally Known OR Produced Identificatio Personally Known OR Produced Identification Type of Identificati Type of Identification ProducedProduced 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 ev. /2014 r Planning&Development Services Department Cou Ty Building&Code Regulations 0 D - 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 properly,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 licab e 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 o me the minimum code. Initia 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 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 lia r t 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 rela e ' I cost,which could�include loss of wages during recovery from their injury. Initia �j 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 Zoning Department to t e Florida State Department of Professional Regulation. Signed and acknowledged on this 3 d day of AR C-: of 20[ . Owner/Builder Signature STATE OF FLORID COUNTY OF The fo oin instrument was owledged before rrie this day o ,20�, by ho is personally known to me,or who has produced _ as identification. 5 O tt Signature of N Type or Print Name of Not (Seal) 7 Title:Notary Pkibtic Commission Number SLCPDSD Revised 05/15/2014 LM= PHREY FF 174772s 6,2019dclic underwriters 17 jam. 0 ,. PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION © 2300 VIRGINIA AVE o FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR-Change of Contractor is to be signed and notarized by the property owner, an the ne a 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. Date: Y-3 0 - / S- Permit Number: Site Address: a- erS6 tS QS( e-S Ke. S r Wd,Y' RD f-7- ST'• L U ce, 35�9S a State License SLC License Original GC,subcontractor or owner/builder State License SLC License New GC,subcontractor 1 1ri l Reason for Cancellation CA-14. .,/�A-1 • The undersigned does hereby agree to indemnify and hold harmless St Lucie unty,i s 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 contractAr/,subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed. . (SIGNATURE OF OWNER(or owner ilder) L XSIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) v�v PRINT NAME L n e w PRINT NAME State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument was ackno34dged before me this The following instrument was acknowledged before me this day o 20byday of .20_ by whoispeolno�e who is personally known to or who has du - •a me or who has produced as ID. Signature of Nota Date Signature of Notary Date Revised 04/15/16 r �I AUDREYB.HUMPHREY �. MY COMMISSION#FF 174772 -J EXPIRES:March 6,2019 9ofldad Thru Notary Public underwriters pl ii