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Home My WebLink AboutChange of ContractorPLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION -m _ 2300 VIRGINIA AVE E FORT PIERCE, FL 34982 AA"? Q 772 2-1578 462-1553 FAX 467 ?0? ST-. Lucke —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: 3�25A_, z� Permit Number: e2001— Aq.7, LicenseO,& "/�53�/99 SLC License New GC, subcontractor Reason for Cancellation y a C, a 6. a a It S- G es o- 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 perriliit¢�A permit canno e c - celled if wor hasbee=permed. !i�-- 'SI ATUREO OWNER (or o1wner tl er)�iSZI'iNA�1 GEGENERAI.CONTRACTOR (or new GC, as plies/ble) PRINT NAME<O�'eT h Y'Y� ).�. - PRINT NAME_I sW (,eJ •Lem L'd�f>L -renre9sf W 1t0 x State of Florida, County of St Lucie County State offferide County of-Sp-Eude County The following instrument was acknowledgepf rre me this The following instrument was acknowledged before me this day of 202 DD by dQSkp 7I L • of &Ia YYri, 201_& by "rr a who is ppersonally known to me r�day 1t,trrd L &1-10C who is personally known to or wh rn produced ' asID. me or who has produced D• L • .11). - I�, ,yy, r2.A ��2'+S`r� N� a Signature or Kota Date Signature o to �� STATE ' • G` OF ' :TENNESSEE: Revised 04/15/16 = •, NOTARY "SYy; NueLl V EV :. AUDREYB.HUMPHREY r' �ilr* Ct o` 'Y �a i�. Uk COUN 14 COMMISSION#GG300817 \per �i,.s!////71111111111\\\\�bes� ?;;FgFopio` EXPIRES: March 6, 2023 Bonded Tluu NotaryPotr& Undenvdlers op Expires Oo\o 2C;vi.Mil c'1T a m. All APPLICABLY INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: a (} Permit Number: I �1 ' RECENED Building Permit_ Application Planning and Development Services PermttU` 9le county rtoent Building and Code Regulation Division St. 2300 Virginia Avenue, fort Pierce FL 34982 \ -Phone. (7-7-2)-462 1553-Fax. (.7-72)-46Z1578_ Cor irriefcial Residential \/ PERMIT TYPE: Address:'" a3 oil ( i� . 1%l M S ,5�� Property Tax ID #:. t'aS- • 40S ODIWt - cow Lot No. Site Plan Name: Block No. Project Name: ' ig a C k; old t 0 es nelcd ci, fbmVDU6D 4n )Y) -4,tI new (rc6*A!2'k 6t1JdC49UAkt-kos _Tgir,r6 races eb I IQ h law, a �eP I h¢) n r b ✓ie , 6i )o % C�\1\� l Additional work to be performed ,under this permit- check all that apply: _Mechanical _ Gas Tank _ Gas Piping —Shut ters -Windows/Doors _X-0ectric _ Plumbing _ Sprinklers _ Generator Roof' Pitch_ _ Total Sq. Ft of Construction: S • Sq. Ft. of First Floor: _ c Cost of Construction:$ AL57 00000 Utilities: _Sewer Septic Building Height: Name bS -- Name: MOO Address: I•a,S'•ZQ��f? C 2. U/0 Company: t �1 'ar City::.. C' sd/1 tate: Address: L114 (�J�1tiiix/ CayLP Zip Code: 3&9. CV 4 Fax: City: t /o OYU I l J e Stater Phone No Zip Code: 3 7 Q?�L f Fax: u,�� E-Mail:""CI'LiS'rft(--h.33/(DbI) CDM Phone No IF191- = 7 Fill in fee simple Title Holder on next page (if different E-Mail_) A n Pj \ G b 0 H 5 12 6 i p QA 4e from the Owner listed above) State or County License r-6C /25t%/ L%-� 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. ' 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 is in which 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 WMt YOUR LENDER OP. Abil AUbRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEME r ature of wher/ Lessee/Contractor as Agentfor Owner lgnature of Contractor/License Holder STATE OF FLORIDA ` STATE OF R F'V)y)eSS<-e _ COUNTY OF c LQ COUNTY OF U 1l The forgoing instru a it was acknowledged before me The forgoing instrument was acknowledged before me this day of 20Z by this 1 day of YCk. 2020 by wAyd L ee -'Name- per n making-siatement.' - `-�`\-"` `- Tlame ofVeerson making statement- — '- Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification P duce d Type of Identification ^ Produced Drlvc+s C1ca1ee J��\tS.tgR0 WN/H /�4i njy� i n Lure of Notary Publ State of Florida g ry (Signs ure of Notary Public -State o_ orytia e Commission No. (Seal) TENN�.S SEE Commission No. _ •, (�f�a%Szi ;.v :';:••; LASHAHNAINGRAM•RAHMING c • PUI3LIC.y REVIEWS FRO '"` :M #NWRES: Ssi PLANS VEGETATION SEATUfIT�2'111111I L"P'"REVIEWOVE `\\\`^ COUN iFJ °`•• Th" EVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.