HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
N= `"`` " BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEA 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.
Date: D 1 Ig Permit Number: 0 T V
Site PI'46Z_Address � T i r/( 77 ( �7
t ' —o ,
State License SLC License
Original GC,subcontractor or owner/builder
X 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 cancellation of permit.A permit cannot be p. elled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME , L [Jr PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County o t.Lucie County
The fo owing&entasdged before me this The wing ins as ac ledged before me this
day ofbydayof 2 _,by
ersonally known to me who is personally known to
or who has pr me or who produ ID.
Sig atur of Notary Date Signature of Notary Date
tPpY P(,B/�
KAREN S. NIELSEN
o State of Florida-Notary Public KAREN S. NIELSEN
Revised 04/1 _ *= Commission# GG 207484 prap.,,'
My Commission Expires �_��" a��;State of Florida Notary Public
2022 Commission # GG 207484
e
June 12, My Commission Expires
°;;;�0 June 12, 2022
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED wi
Date:_ 2 �� �� Permit Number:
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pan
k IV 0
Building Permit ApplEB 19 2020
Planning and Development Services �JBuilding and Code Regulation Division epartment
2300VirginiaAvenue,FortPierceFL34982 �ouJw�vS� �e C nty, FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial
PERMITTYPE: 70 E��S��vG 7oldi�!/vr/SG�'
PROPOSED t PR01/EME CAS N:
Address:. A IA 4Pr. X- fr y0l
Property Tax•ID#: --D/67-07-0 - Lot No.
Site Plan Name: 6*1-L[_p y rO1c�JVlfDr/�� Block No.
Project Name: FLX.It e
DETAtLt DESCItiQ014
gawnRK;
MA &,f'WX /7d AvLe= oG
CONST UGTtO INFORNtPiT1�N
Additional work to be performed under this permit-check all that apply:
�Chanical _Gas Tank —Gas Piping —Shutters Windows/Doors
r�Electric y Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: /7!J Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: ewer _Septic Building Height: /9?
OWN NER/01:b!X=E: Cf3NTRACT1 9R:
Name. L/S/;' sdet/S Name:
Address •Zf30._s-.N. fi-kyA CIA- A&.'W Compa
city: �f1.t�; .iD a'%Jf.4i+�tr/1l -�`v _State: EZ- Ad '. o
CoalAtt.tO^` � .:.r..��•.;••�,.�rli,,.: .
Zip ode: ,• `f. _ `Fax:��= :" : :�� City: rL.!+gin :� >. ;ti; to e:
Phone.f�o,; Zip Co". X.: -
E-Mail: •__..a,.,.:._„r,;:.,��-:.:�,.;� Phono`•
Fill in fee!simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or e
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.
0q; M— RE-1
1 T � � � y"is.;`=1.2.r1+ w_
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 paying twice for
improvements to your property:A Notice of Commencement must be recorded in the public records of St.
Lucie County 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.
Signature of-owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF k' -� T 1�1 I COUNTY OF
Sworn to(or affirmed) nd subscribed before me of Sworn to(or affirmed) and subscribed before me of
P sical Pre n e r Online Notarization Physical Presence or Online Notarization
thi day of 12020 by this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identifeeto' Type of Identification
Produced L ✓ A Produced
(Signature of otary ublic- nature of Notary Public-State of Florida)
B, K REN S. NIELSE
:o - Szz to QQf Florida Notary P blic
Commission No. =2 :_ C�� dnission # GG 207 �o mission No. (Seal)
°, My Commission Expir s
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Or.bMCM
��....
(t�(0 Planning&Development Services Department
`Q�.,o,;r,• o:, 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 oven
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 and by coun .
or municipal licensing ordinances.
Initial Here. �
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 Here.
You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perfo
the work being done. Your construction must comply with all applicable laws, ordinances, building codes,
zoning regulations. Initial Here.
I understand that the building official and inspectors are not there to design or give advice on how to re!A_
minimum code. Initial Here.
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 Here.
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 tkq
license. Initial Here.
I understand that at if an 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 medical cost, wh'
could include loss of wages during recovery from their injury. Initial Here_'
e appear,
To qualtfy for this exemp tion under this subsection, an owner must p rsonall y sign the building permit
application,and initial the above
I hereby acknow dge that I have read and understand the above disclosure statement and that I farther understand
that any viol,. n of the terms of the owner/builder exemption shall a reported by the Building and Zontn
Departn to e Florida S to Department of Professional Regulat' n. igned and acknowledged on this a?
day of of 2&0
Owner/Builder ignature
STATE OF FLO _
COUNTY OF — f✓.
The fo egoin instru . t was acknowledged before me this day of 20�
by who is personally known to me,or who has
produced as identification.
Signature of Notary Type or Print Name of Notary (Seal)
Title:Notary Public umber
KAREN S. NIELSEN
.1P OB
` _State of Florida-Notary public
_* •_ Commission # GG 207484
My Commission Expires
"""`� June 12, 2022