HomeMy WebLinkAboutChange of Contractor, new permit application and owner builder affidavit 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 PERMIT
PLEASE SELECT ONE OF THE FOLLOWING:
X 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.
I 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.
10/05/2021a T��
Date: Permit Number:
Site Address: 594 Beach Ave,Port St Lucie,FL 34952
State License SLC License
Original GC,subcontractor or owner/builder `
State License SLC License
New GC,subcontractor
Reason for Cancellation Abandonment of Project,Mismanagement of Funds
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 cancelled if work has been performed.
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SIG PATUAREOF OWNER(or owner/buitder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME Devan D Wilson PRINT NAME i
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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�,20 0�k,by day of 20_,by
Ze A 30 \,K1�9C0 who is personally known to me who is personally known to
or who h oduced \ Ll�1._as ID. me or who has produced as ID.
Signature of Not-rFJ Date Signature of Notary Date
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VA
Revised 04/ -. 6 �i St:to FL-UE UGHN
of Florida-Notary
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s,on # GG
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Un%%\. Commission O Expires
October 22, 2022
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/05/2021 Permit Number: (
91Y.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: Pool
PROPOSED IMPROVEMENT LOCATION`.
Address: 594 Beach Ave, Port St Lucie, FL 34952 E, r2 a nd
Property Tax ID#: 3419-510-0237-000-1 Lot No.all of 6
Site Plan Name: Block No.19
Project Name:
J0
DETAILED DESCRIPTION OF WORK:
I
Niew Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
1 work be performed under this permit—check all that apply:
Aldditional o k to p p
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction 3333,god Utilities: —Sewer _Septic Building Height:
OWNER LESSEE: CONTRACTOR:
Name Devan D Wilson Name:
Address: 594 Beach Ave Company:
Port St Lucie
City: State: FL Address:
Zip Code: 34952 Fax: City: State:
Phone No. 772-201-6070 E- Zip Code: Fax:
Mail: devdwilson(@aol-com Phone No
Iill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
i I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL GONSTRUCTIbN'LIEN LAW INFORMATION
x
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: Goldwater Bank
Address: Address: 6363 N- State Hwy 161, Ste- 510
City: State: City: Irving State: TX j
Zip: Phone Zip: 75038 Phone: 977_snS_2R6-
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. i
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
Which conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners 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.
Signa ure of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA V\T
COUNTY OF \T
Sworn LD(or affirmed)and ubscribed before me of Physical Presence or Online Notarization
this day of 20QA by
Tip 1)('JUU W 'l
Name of person making statement.
Personally Known OR Prodp-ced Id tifi�on
Type of Identification Produced f—C—
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(Signature u is- public
av a�
=o•P B< State of Florida c a
Commission •= Gomm- n #Jon on 9
ExpiresOete 02
° 2022
Oii��Q�` ber 22• `
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 2 2
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Planning&Development Services Department
[l D n ^- Building&Code Regulations
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S.489.103(7)EXEMPTIONS
i
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 II
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 county
or municipal licensing ordinances.
Initial Here �^
u � ly
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 Herep�
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, building codes, and
zoning regulations. Initial Her9,
I understand that the building official and inspectors are not there to design or give advice on how to m et the
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. 1 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 the
. license. Initial Here.
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 medical cost, which
could include loss of wages during recovery from their injury. Initial Here.A
To qualify for this exemption under this subsection, an owner must personally appear, 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 Zoning
Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20 Q
i
caner colder ignature
STATE OF FLORIDA
COUNTY OF -
The foregoing instrument was ackno ed-b`efore me this�day of 20 ,
by p'LNCA1 who is personally known to me,or who has
produced r. as identification.
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VAUGHNSignature of Notary Type or Print ame of ofda-Notary PublicTitle:NotMPublic Commission Nber n # GG 270oesission Expiresr 22, 2022
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