HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT. SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE MAR I 20�
FORT PIERCE, FL 34982 ��
772 462-1553 FAX 462-1578 ST. Lucie Cotlnt Permitting
I � � � .F�er�rnttmg.._
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.
3
Date: I n (� r t
I 2b�`2 Permit Number: � '1� I
Site Address:
State Licensac.Jsv LC License
Original GC,subcontractor or owner/builder
(�r`r_d�L o �Ib�,,&&Ie_ 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 dams es arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subco actor or cancellation of p rmit.A permit cann a cancelled if wo k has been erformed.
SIGNATURE OF OWNER(or owner/builder) 1 SIGN GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME -ekt4 ti PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
Th following instrumint was aclmowledged before me this I t .&J10 wing' sir trument was acknowledged before me this
day of 0 by I-� —da of ,20 6
C is personally known to me �y
p y1Ciit L!12 who is personally]mown to
or who has aroduc L L a i s ID. me or>Khas roduced as
3 to 2020
Signature of Notary ignatu otary Date
`�otPaYP�a�� KAREN S.LNIELSENState of FloridaPublic; oc Commission 484 (; rru NotaryPubiioStateofFlodda
Revised 04/15/ 4My Commissres g Angle Tatlana Perdomo
June 12 ` My Commission GG't45W 0
a'� Expires 0812612020
+R Planning&Development5ervices Department
COUNTY Building&Code Regulations
FLO ' I D 2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553 MAR 1
2020
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT ST. Lucie County, Permitting
-F.S.489.101(7)EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied fora 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.
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 by county
or municipal licensing ordinances. Initial T _
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. Initial C T
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 applicable laws, ordinances,builldm?codes,
and zoning regulations. Initial 0
I understand that the building official and inspectors are not there to design or give advice on h w to meet
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 C -T
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 GT
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 d tical
cost,which could include loss of wages during recovery from their injury. Initial
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 t the Florida State Department of Professional Regulation. Signed and acknowledged on this
10
day of of.20r76 .
-CA2,9ya 4,
T r
Owner/Builder Signature
STATE OF FLO
COUNTY OF
Th
foreg ing ins ent sac ow edged before me this�day of � 20� ,
b who is personally known to me,or who has
pro uced as identification.
Signature of liota T of Notary (Seal)
Title:No1M Public 7 KARE EQist4Nm r
ny blic
��
=o`� B<< State of Florida-Notary Pu
SLCPDSD Revised WIN mission
Commission # GG 207484
_•
missi 2022Expires'
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: of V V " Permit Number: -10.1 Q2,5 1
Building Permit Application MAR 18 2020
Planning and Development Services -
j Building and Code Regulation Division - ST. Lucie.County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
RO O END IM M711 C3N LO ATION:
Address:_`�� � L13
Property Tax ID#: U Z (J � L `( � ` �G 'b Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�SC«RIPTfON OF WORK:
t �► �' c,-� t, ` ��` - • UVuv(C !S ct f"Ivf 7 cJ�e
f� cL, r C,'fc_�e,
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CONSTRUCTION INFORMNOON
Additional.work to be performed under this permit-check 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:$ 00 Utilities: _Sewer _Septic Building Height:
1 QW. N i @ R,7%1 INNNTRACTOR:
Name Cv21 yv� 4 ��} Name: ,
Address�US ��-t ( Q Company:
City: '�' �1 �-��e State: L Address:
Zip Code: 3� �$ I Fax: City: State:
Phone No. �7 2" �.Ul 7U� ..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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
WRV6 N AL CONSTRUCTIO R MAM RMHUM,TIO :
DESIGNER ENGINEER Not Applicable MORTGAGE COMPANY: Not Applicable
Name. kV-cJI e- ��l ct �i Name:
Address: o- ' Address:
City: 8tote: City: State:
Zip: 3 QY4 Phone 2` U v 8 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,JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND)PR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The f oing instrument v1 as acknowledged before me The forgoing instrument was acknowledged before me
this day of. a 26T by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identificastm Type of Identification
Produced b Produced
(Signature of Notary Pu (Signature of Notary Public-State of Florida)
tPpv ale
KAREN S. NIELSEN
Commission No. ;_° ��:State(g�filprida-Notary Public Commission No. (Seal)
_* *= Commission #GG 207484
o. My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.