HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
Ji BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 SEP 10 2020
(772) 462-1553 FAX 462-1578
Permitting Department
St. Lucie County
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAK SELECT ONE OF THE FOLLOWING:
r 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: 7� / Permit Number.
Site Address: !//--�
A Ott / CJ,S State License SLC License
Original GC, subcontractor or owner/builder �
I tf— y 111 S S��V AD✓� State License G�� G I SG7"�y!`-Si.0 License
Ne , subcontractor
Reason for Cancellation
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
contra r/subcontractor or cancellation of permit. A permit cannot b cancelled if work has been performed.
SfGNATURE OF OWNER (or owner/builder) SIGNAT GENERA ONTRACTOOR (or new GC, as applicable)
PRINT NAME MAf e_� Fos PRINT NAME LJC'IVla+i/L(%fy lam. /T4lClr�-Ll�-
State of Florida, County of St Lucie County State of Florida, County of St Lucie County
IThne fpRowing instnun t was acknowledged ore me this The oliowing in trumen was ack n led ged before me this
day of 20a?O � day of 2VGby
s otsally known to me TJG 0 who is personally (mown to
a as o wed meorwhohasproducW ro6n MID.
�Sismr o Notary Date Q I c, a 0 J-Q Signature o ohry Date
FFUNCIS FOg8E5 y: KAREN S. NIELSEN
F, State of Florids-Notary Public
Revised 04/15/1 f . -�� _ Notary Fhrdk-Strtedrbrida Commission II GG 207484
h�7a Commissionar,(113873 h�7-
Ay,Comm EapaesOne,2021 My Commission Expires
•.'?Y�;=. a`,` June 12, 2022
amaea�a9F Maapal Nobry Wn.
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
S - Building & Code Compliance Division
•
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
A/V_ 0'4 t11/CAJ Jcc . have agreed to be
C mpany Nam /Inddividual Name) �
the S u �dt/ Tay, Sub -contractor for f
(Type of Trade) (P ' ry Contractor)
For the project located at 176 e-fk- Lazl f_
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
—�'_ �
CONTRfTOR SIGNA (Quefifier)
ti C .
PRINT NAME
COUNTY CERTIFICATIONIB
State of Florida, County of i
he foregoing Instrument was sign ¢fore me this
w r� 20 � wh ce nslly known r or hae produced a
STAMP
Print game of Nots
Notary Public State or Florida
s°� � Pamela Wi�llams
E)i Commission 080H 010265
EaPtf09 08106/2024
Revised 11/16/2016
SUB -CO RACFORSI ATURE(Qualifier)
PRINT NAME
70UNTY CERTIFICATION NUMB
State of Florida, County of
T foregoing i strument was sigfore me this day
of
2 by ce ¢l ,
who p pe elty (mown L, or bes produced a
RE9D
ate of Floodss024 010265
STAMP
�"
! YK�1tCl3F2
All APPUCABJW I O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Qq ��yy ^2
Date: f 7D zozo Permit Number: IIOT� 05lq
���� y RECEIVED
s SEP 10 2020
` c Building Permit Application Permltting/Dopant
Planning and Development Services St.Luc
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 I)
PERMIT APPLICATION FOR: �a ter— Scams LCirtfl�/ a ,� c
PROPOSED IMPROVEMENT LOCATION:
Address: 176
PropertyTaxlD#: 3` iq Lot No. a- -
Site Plan Name: / ,A Block No.
Project Name: lill!S101014161)
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply: /
mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors _Pond
_V lectric _VPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: , ��� tE - Sq. Ft. of First Floor: 117fi
Cost of Construction: $ 7U,��� Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mi
Name:
Address: y�� N1✓ Ce 1 -e—
Company:�t-
City:, L�'C State:%�
Zip Code: 3`>� Fax:
Phone No. 772-^20/" /6�
Address:
City: /6-T- tS"�
Zip Code: 37 tp Fax:
Phone No 7 2-2/ 5V3
StateAL
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License /✓
Z 3
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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
Signat of Contract /License Holder
STATE OF FLORIDA
STATE OF FLORIDA I s
Zi—Is
COUNTY OF
COUNTY OF 11ii J
Sworn to (or affirmed) and subscribed before me of
SvjKn to (or affirmed) and subscribed before me of
_ Physical Presence or _ Online Notarization
Ph sical Prej�nce or Online Notarization
this _ day of 2020 by
this�y1d f/���t_/.c .2020 by
Name of person making statement.
Name of p on kiinnLstatement.
Personally Known OR Produced Identification
Person ly K own R Produced Identification
Type of Identification
Type laden
Produced
Prod ed
yp of FlW>da
(Signature of NotaryPublic- State of Florida )
Commission No. (Seal)
���
(Si nature of Notary u} tefUl+WHr „Hrl oozes
E:P eeoWe2o2+
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
PERMIT # ISSUE DATE
--
PLANNING & DEVELOPMENT SERVICES
- - 'COUNTYBuilding
& Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
GRIMES HEATING AND
AIR CONDITIONING
(Company Name/Individual Name)
the MECHANICAL
(Type of Trade)
Sub -contractor for
(Primary Contractor)
For the project located at 176 ESTIA LANE (3419-540-0008-000-0)
(Project Street Address or Property Tax ID #)
have agreed to be
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
744-1.Laz&
CONTRA70R SIGNAT (QnSMi )
PRINT NAVIE
COUNTY CERTIFICATION BJ��
State of Florida, County of ' n
e foregoing i�ntrumeot was signed before me this v/ day of
`}201�by
who ifper*maI1y1mmsmV or W prodered a
STAMP
Print Name of Notary Public
Revised II/16/2016
ONTRACI' St G ATURE
JAMES F. GRIMES SR.
PRINT NAME
lid/
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST- Lc c,
The foregoing instrument was signed before me this � day of
Al Q�, 20.2Q, by Z'L m C.S F. G I"I rrIGS
who is personally known�or has produced a
as identification. C
STAMP
ego stare of Notary Pnbtir
Print fsInme of Notary Pnhlie--T
SUSANMONTENEGRO
MY COMMISSION # GG 089099
EXPIRES. Apn12.2021
�...y2r', 9aidM Thn, Notary Public Undem le s
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
a - -- BURRING PERMIT
SUB -CONTRACTOR AGREEMENT
eHc-S-Ame, e/— have agreed to be
(Company Name/Individual Name) )
the E�Igg-,I4—, rn ) Sub -contractor for /tr- C4Cyls JG^
(Type of Trade) Contractor)
For the project located at /715 Z,S),i2
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
4, (L avx
CONTPACTOR SIGN E (Qualfi er) SUB -CONTRACTOR SIGNATURE (Qaaliser)
P AME V PRINT NAME
COUNTY CERTIFICATION NUMBEA
State of Florida, County of (,4�
,Th1e foregoing A Pstrunient was signed before no, this day
o}f-r/ V
26
who I(/personaily known—)L_or has produced a
STAMP
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing imtrono,nt was signed before me this _ day of
.20— by
who Is personally known _or has produced a
as identification.
STAMP
Signature of Notary Public
Patl Wo' of Fbnea
t ()jC[ Print Name of Notary Public
Ez0 es 0810612024 010265
Revised 11/16/2016