Loading...
HomeMy WebLinkAboutChange of Contractor ALLAPPLICABLE ICABL E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / �p Date: Permit Number. ! ti 1 0307 i R Building Permit Application JAN 17 2019 Planning and DevelopmentServices Building and Code RegulationDivisian Permitting Department 2300 Virginia Avenue,Fort Pierce FL 34982 S L 1v e nty, FL Phone:(772)462-1553 Fax:(772)462-1578 Commercial PERMIT APPLICATION FOR. To Select from dropbox, click arrow at the end of line PROPOSED iMPRtJVEMENT LOCATION. _ Address: 0rk d Legal Description: CSS ,�j ,3 c( T�l4 Eq v4-t3 5©G � cSllC7r-A /n d R, -" r Ld f- t cl l acid✓n d C/'f� Property Tax ID#: - .3 6 6. -5-dl Q 06- Lot No. � Site Plan Name; N C3 GI, CBlack No. Project Name: Setbacks Front Back: Right Side:' Left Side: DETAILED DESCRIPTION OF:WORK CONSTRUCTIOWINFORMATlON Additional-work wor to e e orme un er is permit-c ec a appy; EIHVAC Gas Tank ❑Gas Piping _Shutters Fl Windows/Doors Electric 0 Plumbing []Sprinklers FIGenerator Roof Total Sq.Ft of Construction: �� So_Ft.of First Floor: / d Cost of Construction:$ Utilities: Sewer Septic Building Height OWNER/LESSEE COfitfiRAC7170R Name ,5o 'Y Name: C. C Addresl, Company: j r City: Pffornvc e.. State: /� Address: 1 Zip Code: L l��t Fax: /j/l/ CityFf 1'�+P� State: 1�G Phone No._( 03 F1 0 Zip Code:,-3,Lfff 5'� Fax; Cf46G- F� E-Mail: 4- Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: Ce tr ��ltCf from the Owner listed above) State or Coun icense: ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required. I r r ESIGN ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable ame. Name.* ddress-. Address: CR,y; State: Cily: State: Trp: Phone. Zip. Phone. FEE SIMPLE TITLE HOLDEN- Not Applicable BONO1NG COMPANY: Not Applicable Name• - Name Address: Address+ City: - � - Zip: Phone: Ar. Phone: t osr*that noivo*or lr,sWb Ion has commencer!priortothe Issuance of a permit St Lude Cou ttyymalaes no rep on that granting�=agt fire�rmtt holto!wildthesubiect strucWreAor a�td oavenarrts at may r or prohibit such OwnersAmodayour dem for any restrictions which may apply. in consideration of the granUng of this muested permit,i do herebyaigree that I wilt,in all revect&perform the work in accurdanm wuh the approved piatm theFlorld•s Su f&wCodesand St.Lucie County Amendments. The fbilowingliaft pera t'appkations are exemptfrorn undergoing a fall concurrency re4ew:room additlom accessary mucsums,swiianft pools,fences,wafts,signs,scremmom%pnd accessory uses to another non-redderniai use WARNMO70OWNEIL-Yourfallumt*RewfdallotkoafCmwnenemeptn=VMMI It in yotir4oaiylt>N iwioe fvr Improvements to your property.A Notice of Commencement must be recorded and Posted on the jobsite before the first Inspection.If you intend to obtain finanda&.eonsult with lender or an attorney before commencing work or recordina vour Notice of Comrimencergent. re of owner Agent/Lessee Signature of Contractor Ho STATE OF RORIDA STATE OF�F' NDA- COUNTYOF :S-6- {--t t UA g . COVN Nr 4 lbefix --ftbwmumernwasasa�r�tedgedbefore-me Theforgoinghommentwasacimowledgedbe�reme thls�,•day of Zp by this -day of �a y"t- .20,.-a by (name of person sdnnvh dging) (NarrteWpewnad wwlefting) Y ' (ftv tore of Notary Public-State of Florida) (Signature ol'Notary Public-State of Mrida) Personally Known OR Produced identification Personally Known O 7+ype of Type of Identification Prod ELLEN VA[jrH-N Y PV i �? tate of FiQrida-Notary Pubi °'.State of Flgg��id��a,,-��llotary Public G a�Q / _* *_ �ss!on #GG 27007 - Commissfon Commissti3�1JGG 270079 tArr�missiort No' ""���,�o mmFssion Expires ~' My Commission Expirgs ""'" b22, 9022 Qctober 22,2012• .r+� Revised 0711512014 • . REVIEWS - FRONT TONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE lNn " PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION COUNTY 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEA E 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. jRoI - o3n,-7 Date: '_ I � ( rt Permit Number: Site Address: I / CO�Or/10 C� I CoLfK State License 7 SLC License Original GC,subcontractor or owner/builder - (2Cc V".11 k 014, State License SLC License (7.1 . New GC ubcontractor Reason for Cancellation C C G +_�7j_Kl The undersigned does hereby agree to ind mnify 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 contr cto ubco tractor or cancellation of permit.A permit canngt ca celled if workhates beene formed. SI NATURE OF 0wA(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME cf PRINT NAME ✓! C( State of Florida,County of St.Ltbre nty State of Florida,County of St.Lucie County The following instrument was aged before me this a lowing=' was aclno ledg ore me this day of G W 2y cS day of20 f by +r i j a-- r� n C r U W` ersonally known to me who is persona own Cg'Yf e f-- or or h produced s ID. me who has produced ID. Signature of Notary Signature of No Date Revise , t�tcrv, PATRICCARTER o� . s' AUDREY B.HUMPHREY_., t.I CommiF 177927 _' '_o Expires9,2019 =; MY COMMISSION n FF 174772�� eodnww�,�eoaaesana ,, P EXPIRES:March 6,2018 a +' ''•;od •� Bonded Thru Nota Public Underwrit,.rs t ry