HomeMy WebLinkAboutChange of Contractor � - v
PLANNING & DEVELOPMENT SERVICES
- BUILDING & ZONING DIVISION. RECEIVED
,COUNTY2300 VIRGINIA AVE
D. FORT PIERCE, FL 3.4982 JAN 2 6 2022
772 462-1553 FAX 462-1578 St..Lucie county,
Pernii0ing
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: ��i� ��' Permit Number: `/��
Site Address: ,Q7j`'l�5 �yof'
/✓I�—State License SLC License
Original GC, subcontractor or owner/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 cancellation of permit.A permit cannot be cancelled if work has been performed.
)GWNATURE OF OWNER(or o er/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME '54. PRINTNAME
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
W* day of?Q,� ,20_21� by Q+v day of 20_,by
who is personally known to me who is personally known to
or who has produced 5;'*"0^' as ID. me or who has produced as ID.
Y o Notary l OA GIVENS
Signature o g , p" Signature of Notary Date
u State of Florida
Commission M HH 086359
M Comm.Expires Jan 28.2025
Y Ex P
Revised 0, 5 68
ended through Nationai Notary Assr.
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /��e+7L �- Permit Number &Z
gm.LLia,- RECEIVED
Building Permit Applicati®nJAN 2 6 2022
Planning and Development Services St.,Lucie Cou
Building and Code Regulation Division Commercial Resideftrahin.
IN
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
z _.
-NO
- - E X �
<�.a .. x
11
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit—check all that apply:
_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:
00 _
Cost of Construction:$ /y �L) Utilities:i/Sewer _Septic Building Height:
Name
Name:
Address: Compa'ny:...),. .
City: 7�a State:_ Address:
Zip Coded Fax: City: State:
Phone No. �v Zip Code: Fax:
E-Mail: Phone No
Fill in 4e 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 HAVC is$7,500 or more, a RECORDED Notice of Commencement is required.
I
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/C ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF !A
Sworn to(or affirmed) and,subscribed before me of _Physical Presence or Online Notarization
thisapf,__day of`Spl ,2C8�by
Name of person making statement.
Personally Known OR Procl Iced Identification
Type of Identification Produced VL- tL
(Signature of Notary P ic-State of Florida)
C
Commission No.�}A M'�e . ( �FIVENS
Notary ate of Florida
Commission 9 HH 086359
?of My Comm.Expires Jan 28,2025
Bonded through National Notary Aofn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21
ku
t -gAIr JL(LE(Zi' :MW
p Planning&Development Services.Department
• Building&Code Regulations
_ 2300 Virg►ma Avenue
Fort Pierce,Florida34982 RECEIVED
772 462-155 3
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT J.AN 2 6 2022
F.S.489103(7)EXEMPTIONS. St-Lucie County -
mitti
State law requires construction to be done by licensed.contractors. You have applied for a permit Mder 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 and by county
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 perform
the work being done. Your construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations. Initial Here.
I understand that the building official and inspectors are not there to design or give advice on how to meet the
minimum code. Initial Here. Lr
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 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. /fir
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,.JZ,1 of2(,'7
l—
OwnerBuilder Si re
STATE OF FLORIDA
COUNTY OF c
The foregoing instrument was acknowledged.before me this 96 day of �S cs.-,r, ,20 aa, ,
by �a ¢ �a^!1 who is personally kno _
produced '� �' L. as i "on. DEANNA GIVENS
j Notary Public.State of Florida
\ t Commission#HH.086359
iLCl�9�,r. G t orR My Comm.Expires Jan 28,2025
Signature of Not Type or Print Name of Not Bonded through NatiaF�ldary Assn.
Title:Notary Public Commission NumbekA v�
PERMIT 6N a.�p ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division - aECEivE®
COUNTY
BUILDING PERMIT JAN 2 6 2022
SUB-CONTRACTOR AGREEMENT
St.Lucie County
Permitting
have agreed to be
(Company Name/In idual Name)
the �� �,����� Sub-contractor for
(Type of Trade) (Primary Contractor)
For the project located at /1� S.E�YG;c(' Sz�(Project Street Street Address or Property Tax ID#)
It is understood that,, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St. Lucie County will be advised-pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNA cc E(Qualifier) SUB-CONTRALTO IG/ /URE(Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County of Oy.'"t!
The foregoing instrument was signed before me thiP"S day of The foregoing instrument was signed before me this 4 day of
" � zoaa,by�a���t� In w�..�►,n "5a� ,zoa4 by '��►;1\e mil^"P9r,
who is personally known or bas produced a L who is personally known or has produced a V L
as identification. as identification.
STAMP `STAMP
Signature of Notary Public Signature of Notary Pu lic
Print Name of Notary Public Print Name of Notary Public
OEp�Npowo Flo-da
?` otar!Pubvr dtHN 0a1a 1015 '^5,..v e;.• DEANNA GIVENS
&. N tss�p°. an 'A a Public-State o Florida
Notary
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iz a; m tx4 NotatY sue; Commission HH 086352025
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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division RECEIVED
COUNTY
BUILDING PERMIT Jail 2 6 2022
SUB-CONTRACTOR AGREEMENT
St.Lucie County
Permitting
have agreed to be
Company Name/In ' iduat Name)
the y-4%NV-,-1, Sub-contractor for
(Type of Trade) (Primary Contractor)
For the project located at C1 <
Project Street Address or Property Tax ID#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the .
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNA E(Qualifier) SUB-CONTRACTORIG URE(Qualifier)
PRINT NAMt PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County ofr.��e�
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this day of
"�,r zoa�a,by��a� g �1�.�,��.�►-r� _�5Q►�_ zo�by '��►a\� �^�__4'h`�
who is personally known.—or has produced a to L who is personally known_or has produced a �-V O L
as identification. as identification.
i
STAMP STAND
7�� 7i � I
Signature of Notary ublic Signature of Notary Public
Print Name of Notary Public Print Name of Notary Public
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tary Public
Z �°fi m,ExPitQS;Notary a5S° ����? Commission State o HH 086359
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