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HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES BUILDING& ZONING DIVISION COUNTY 2300 VIRGINIA AVEC FORT PIERCE,FL 34982. (772) 462-1553 FAX 462-1578 JU'nG� ST. Lucie County, permitting CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR—Change of.Contractor is to.be signed nand notarized by the property owner, d 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..Thece 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: 117 20 2,0 Permit Number: S L C- ZG r, 5-oo bC Site Address: 01 Z Vic, n. b v o C v C Pal+P1 erLC. L 3`2- V `2V State License 'SLC License Original GC,subcontractor or owner/builder r �%r'N t��L M G State License SLC License New GC,subcontractor pp L / L Reason for Cancellation i's Ul ,� 0 1 L p t��'1 G4''+• �Gr tL. C��T cx o + �Vtvw �rs. 5 0 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. .SIGNATURE OF OWNER WNERq(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME N ti[ i MG 11 r.Cr t PRINT NAME 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 ��. day o6 v+� .20�by �G a.1% day of 20_by `tn 6 %v.,q,C% who is personally known to me who is personally known to ^qI who has produced 101— as ID. me or who has produced as ID. Signature of Nota Date Signature of Notary Date OEMNpi"EGNENS ,s} d p ISSloN#bet 8,20203 $ £ � �_ EXPIRES Decep sr. ; gondedTtuuNotazY�hlcUnde�w�itera NIN ,,,, All APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number:S L—G 2'''GS —G G i JUN 2 2 2020 Building Permit Application ST. Lucie County, Permitting Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (77'2)462-1553 Fax:,(772)462-1578 PERMIT APPLICATION FOR: L Address: a 12 �J Gz.� o a �T• �—� r (•�Gt, �I_ 3y07V2 Property Tax ID#: 3 K ` —(� r 0 aS6C;' O 6 �� Lot No.�_ Site Plan Name: r Block No. � Project Name: }`�,7,.. '„ �?j °�fk rr h rr"""'5 "7'' ©ETAtLED ©ESC {PONF VIIQRKH4t � [Li &41ce e a-[C'r'!!) �V �(,(°5z 1�8iG —�GJ`oQ e7I�'I, �GivGS civ1 (iVL� Si� Z � t��s� V_C.Inc,e. It Z J- G od S f*d2 o G . New electrical Meter Second Electrical Meter CUiSTR1CTl tNl t3 t1t[JT1t3N �� 3 :,g 3,"= 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:. n I •F Sq. Ft. of First Floor: Cost of Construction: $ ���� • a Utilities: _Sewer _Septic Building Height: z "�. p '° o �I�R1Lss GontTR�cn�R : r"o Name /JoALL /Vlo I ,nc,r i -Name __.._.. . .t- Address: 1�90[ Z City: t'' ' $r zrc:c. State:'�1. Zip Code: 3498-2- Fax: .City: -' State: Phone No. N D Lf c� L( -7 S Zip Code: Fax: E-Mail: n�.fyi o (� r1 W (� i Flo Hce Lc m 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. If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. '>�sc�i ^.� z 'v"�!�-''" ' a" a.. -' „ �,"'s' .. � � .a:!�,�..:,�; h`w'.>v. :.,+�.....,, � '.�°'�Fie• ����n.. DESIGNER/ENGINEER: T 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:Applicatiori'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 thepermit 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/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization this_-�',a.day of _—S untt- 20ad by this day of 20_ by 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 Identification Produced L�L Produced (Signature of Notgry Public-Staoda p *AIM ture of Notary Public-State of Florida) s�: EANNAMARIEGIVt: S MY COMMISSION#GG 02 0 fission No. (Seal) Commission No. a-3-da. ;� a SealtXpl g:"m"e, O 20 o Bonded Thru Notary,publla Unde rs REVIEWS FRONT ZONING SUPERVISOR PLANS' VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.