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HomeMy WebLinkAboutChange of Contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / Date: /�larGh 7 Permit Number: - _ Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 / Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential '✓ PERMIT APPLICATION FOR: PROP®SED fRPR01/EMERT LOCAi'taR: Address: 'V/4/ F"r?t )01'erne 3."v9 4 Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED [ E�SCR�I'PT(ON F WORK: fie- rod .�z�h thin �S. D CO°NSTRUCTION INF®'R1I/IAT'M Additional wor to, a pertormed under this permit,—check all that appy: _Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: 0 , Sq. Ft. of First Floor: ,Z�UOl>✓ Cost of Construction: $ 3 L Utilities: —Sewer _Septic Building Height: OW'NER/LE-�S&EE: FIN Name /,e-)hd. L. er/2- Name: ) Address:07021gLW61 Company: '`/ nCity: �� i�,/'C� State: Address: �MVk IQ (� Zip Code:,3Vq ` 6 Fax: City: -% & FRLE State: Phone No. 711.2 01(/a�7-D7�a Zip Code: Fax: 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. Sl1PPIE-NIE 'NS`�TRl1CTl®N .III'EN lA�U I'IVF®'ItMATIaN: 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 applicatio6s 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 jobsite before the first inspection. If ou intend to obtain financing, consult with lender or an attorney before commencingwork or reco In our Notice of Commencement. Signature wn r/Lessee/Contractor as Agent for Owner gna r of Con'tractor/ se H r STATE OF FLORIDA STATE OF F COUNTY OFCOUNT The forgoing instrum nt was acknowledged before me The for oing instru a as acknowle g d before me this�day of 20Mby this � day of 9 0 by Cons- (Name of person acknowledging) (Name of person a knowledging) w� (Signature of ary Public-State of Florida ) (Signature of N t ry.Public-State.of Florida ) Personally Known OR Produced Identification erspon�allly KKnfjo n 0 Produced Identification Type of Identificati -� $'4 PG9� Produced Produced =• * ""= N ANGELA `aa i + •c !ic HUFF COmmiss State t F & '. (Seal) Commissio o.' ;F;4�` CYCom— I,,, °n F• Ida �cim �b� o. PA26 HIIFF SealF ��3iL ,��LR�A (J rJ ,. , pV Pp•,,, t°Rded Ares •Ex i titro Notary Public-State of Florida y��'''� °91iNatlon� 20;c�- cFP 914 30. •n * a sq Co m.Expires INay 27 2019,,; >s ondedlhroE#QJ%TalNotai ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER"`m `REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED . DATE COMPLETED Rev. PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION ® 2300 VIRGINIA AVE o — 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: /March l &17 Permit Number: Site Address: �a�L1 T /fayu/UDI �7jJ"t /">�TCej FL ©//UrJ Pif" State Licensee!: � � S'—S-LC License Original GC,subcontractor or owner/builder 6 ,4 / L 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 o ancellation of permit.A permit cannot be cancelled if work has been performed. SIGNATURE OF OWNER(orowner/builder) l� SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME �r'P/ `� �'vPRINT NAME 1 State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument was acknowledg efore me this Th ollowing instrument was ac wledge before n this Lr � -day of C`xr.20 by day of ru 20 by l.�J who is personally known to me who is personally known to or who has produced '5L-AF-as me or who has produced L as ID. ( �® ` I r(] Signature of ry a°s, U, Saxe Notar Public State of Florida Signature of , ary �,. 4 , •; Commission#FF 234730 ,,`o��a�P%P�,,, ANGELA M HUFF r" hoc My Comm.Expires May 27,2019, Notary Public-State of F Bonded throughtary National NoAssn.i. = *'c Florida Revised 04/15/16 __ m, _ :" ommission#7 FF 234730 C ,,,,OF FL MY Comm.Expires May 27,POig . Bonded through National Notary Assn.