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Home My WebLink AboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT ~` BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST PERMITNUMBER: I ADDRESS: ZZ� �(�� !' ' " �` L- � FL 1,ki& , we a ,am requesting that the above permit be renewed. I understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a passing inspection during any six month period during the renewal period. Justification lleeol -re et 'd1an5 ed- 71fle 7� r f OWNERBLDR OR CONTRACTOR SIGNATURE DAT" Print Name STATE OF FLORIDA COUNTY OF ' 6 3 YK, -1 ACKNOWLEDGED BEFORE ME THIS \ ` DAY OF �1 20jj__ BY �.oy�A VIN \N)O'A q_t N WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED �' L AS IDENTIFICATION. . TATE OF FLORIDA,County df NI NS �A -Q 61#44411- NIY:ANh4lSS17N 0 GG 0220 1 SIGNATURE OF NOTARY = ExP :(� ��e IBES 1denV�iicry p., =, a onded ThN Notary Public U FOR OFFICE USE ONLY: Number of Open Inspections: Total Inspections: (Divide open by total to get%of open inspections) Percentage: Original permit fee: x%open = $ Renewal fee Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) Revised 7/21/2014 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 SELECT 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.�/ Date: G - ( - --)-d/t? Permit Number: Site Address:-2,;w W). 4PO r I- S7- 44ei'e; ,-f-1`1'fiA fe A.A 0-� ��/��`�, �� State License SLC License Original GC,subcontractor or oo er/builder 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 damages arising from any and all claims of action for any reason,which may arise as a result of this change of contractor/subcontractor or cancel tion of permit.A permit cannot be cancelled if work has been performed. � L , SIGNATURE OF OWNER(or owner/builder),/�/ ,//J SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME nr`;a, �1 9 eJA�'' 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 day of �1 ' 4 ,`�1��alb^ day of ,20_,by H Oma '� t>'°:�s�jiri7�'. ersonal '19n`ti _ who is personally known to or who has pro ced C' tl�}�Y o a's ID�Il COiyi/,gl l—,-#IE C1yEtV5 erre or who has produced as ID. XPiRFS:p GG 022023 ` Bond�,i eCembe Signature of Notary Da to rr ryp�hi'c Undenve.;; j i Signature of Notary Date Revised 04/15/16 Planning&Development Services Department COUNTY Building&Code Regulations 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 OWNERBUILDER 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 ap ica 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 hGovXLt 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 f r e cost of the license. Initial l� 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 medi 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 Zo 1 g Departme t to the Florida State epartment of Professional Regulation. Signed and acknowledged on this day of _ of 20 f t '�• � ®cvl�itG�" OwnerBuilder Signature STATE OF FLORIDA COUNTY OF S-N , %.-.l�\ The foregoing instrument was ackgowledged before me this day of Sy ,201 , by V47N \J TN 0W OW q c who is personally known to me,or who has produced �. Q L as identification. —�" \ pcANNAf�ARIE GNENS �.N- V'y C0h11,41SSi0N#GG 022023 *" EXPIR 2020 Signature of N ary Type or Print Name of Not = S `el uc Unaetv+r-� $ FOFF�o Bonded Title:Notary Public Commission NumberF �— SLCPDSD Revised 05/152014