HomeMy WebLinkAboutChange of Contractor I
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 D E C IQ 01
(772) 462-1553 FAX 462-1578
ST. Lucle County, Per-mittin9
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: 11/18/2019 Permit Number: 1812-0021
Site Address: 10701 S OCEAN DR 816,JENSEN BEACH, FL 34957
MICHAEL HORUTZ State License EC13006338 SLC License
Original GC,subcontractor or owner/builder
FPL HOME SERVICES State License EC13009228 SLC License j1 t4 6)19_'
New GC,subcontractor /-
Reason for Cancellation {��]�{�/zQ f��{�►Q �✓JC["91L
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 cancelle=ifk n performed.
SIGNATURE OF OWNER(or owneribuilder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINT NAME C ✓IS 1 O iii K (/✓
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' s ument was acicn�yviedg or me this
day of 20_,by �da of 2 _,b c�rT�+^
who is personally known to me &k641) v1---whbis personally known to
or who has produced as ID. m h s o uc d s ID.
11118/2019 1 8/2019
Signature of Notary Date g to of Notary Date
Revised 04/15/16 yo�ttlP!��y� Notary Public State of Florida
GESELLA PAULINO
r
Y'. My Commission GG 151455
� Expires 10/15/2021
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1812-0021
RECEI!/ED
I�II
t
DE 0
Building Permit Applicati n
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT TYPE: Electrical
Address: 10701 S Ocean Dr 816, Jensen Beach, FL 34957
Property Tax ID#: 4511-510-0017-000-9 Lot No.
Site Plan Name: Block No.
Project Name: Raffay
MON
a U:000 20-0 03t2 I
IN L
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.-of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
WMW
Name Charles Raffay Name:Christopher Shaw
Address: 10701 S Ocean Dr 816 Company:FPL Home Services
City: Jensen Beach State:_ Address: JQ0bJ \°
Zip Code: 34957 Fax: City: Mai- VC, M 9,1;L"l(4State: FL
Phone No. Zip Code: Mq)`l Fax:
E-Mail: Phone No �j(� I -1�-1 S_1g0
Fill in fee simple Title Holder on next page(if different E-Mail UoO6SynIF-PL OD11
from the Owner listed above) State or County License EC13009228
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
r
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
V_
Signature of Owner/Lessee/Contractor as Agent for Owner " Signature of Contractor/License Holder
STATE OF FLORIDAcc `` STATE OF FLORIDA i
COUNTY OF UT• LUCa COUNTY OF I.UCJI
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of`OQCeryir" ,20A_ by this day of pew 041•,P_,r ,204 by
C��tS�oDltiear �hau�
Ck rid' -�a 12k-9-y- SAca
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Produced Produced
(Signature of PYotary Public-StatEf of Florida) (SignatA of Notary Public- tat
W F-&,, Notary Public State of Flor d
ti PCommission No. ® I is on Nb. ?� `RS ELLA PAULINO
20 ��) Notary Public State fn 5 commission GG 1514'5
GESELLA PAULI OoF�,o' Expires 1011512021
c a My Commission GG 51455
of no xpires iummum
REVIEWS FRONT ZO VEGETATION SEATURTLE MANGROVE
COUNTER .REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19