HomeMy WebLinkAboutMisc Letters ; 'w s - y X 7;; { PLANNING&DEVELOPMENT SERVICES
I tT"ING&ZONING DIVISION I
2300 VIR.GINI[A AVE
- FORT PIERCE,FL 34982 �
(772)462-1553 FAX 462-1575
CHANGE OF CONTItACTQ�SURCaNTRACTOR OR CANCELLATION OF PELT
I
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 m
contractor information and signature. A new Notice of Commencement mnst be filed in the new contractor's na
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior tcI
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 Sar
Contractor.
CANCELLATfON 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. i
I
n
Date: �\��' 1�' Permit Numbers
Site Address: 3605 SLOAN RD
State License SLC License
• I
Original GC,subcontractor or owner/builder
FLORIDA STATE ROOF SYTEMS INC State License CCC1329823 SLC License
New GC,subcontractor i
Reason for Cancellation `
The undersigned does hereby agree to indemnify and hold harmless St La 'e Cotmty,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any r on,which may arise as a result of this change of
,/!rcc:on�trabntractor or cane of permit.A permit cannot be c if work has been performed.
G -�� l
SIGNATURE OF O P� or ownes/builder) SIONA GE CON TRAC M(oracw GC,as applicable)
PRINT NAMS�J�HEMANG PRINTN JOHN MANERA i
I
State offlwida,County of SL Lucie County State of 'da,County of SL facie County i
The followinginstnmwt ackuowledgedbefbre this a llowmg' m mowledgedbefaacmethis
day of_�20� da of 0 L�y
elm who is persona) o me personally known to
or who as ID. me or who h s produced as ID.
SlpllNol Date PETER NUNEZ
Signet-w o N r y Date
•
�otaR NOTARY PUBLIC• ��S�RYgss PETER NUNEZ
oP �� NOTARY PUBLIC
Revised 09/ o STATE OF FLORIDA STATE OF FLORIDA
{, Comm#FF189093 ?Comm#FF189093
s�N I Expires 1/12/2019 CE 190 Expires 1/12/2019
- I
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
e - 2300 VIRGINIA AVE
_.._._..,..,......_.... FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: j "D] b 0 ADDRESS: 3605 SLOAN RD
I, JOHN MANERA .am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
OWNEWBI LA OR rONTRACTOR SIGNATURE DATE
JOHN M NERA
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF �y ,20
BY "J) �' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED IX A064.d AS IDENTIFICATION.
ATE O RID ,County of
��pSdRYq PETER NUNEZ
SIGNA O ARY NOTARY PUBLIC
A
STATE OF FLORIDA
N�E E19"►g�c 'SFF18�319
�� e
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get'%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014