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HomeMy WebLinkAboutBuilding permit app, change of contractor 10.29.20 i i f PLANNING&DEVELOPMENT SERVICES J. '- BUILDING &ZONING DIVISION • 2300 VIRGP41A AVE FORT PIERCE,FL 34982 r, (772)452-1553 FAX 462-1578 a. !CHANGE.OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT y Pi.,EASE 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 F 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-S50;00 fee-for the Change of-Contractor. f ' CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor. The new subcontractor must fill out a Subcontractor Agrecment Form.There is a$50.00 fee for the Change of Sulb Contractor. CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done. Cancellation ofpermit is to be signed and notarized by both the owner and qualifier of record.There is no fee for cancellation of the permit ii ) Date: 1 U �� �2aZC� Permit Number. ��� " C Site Address: 5©'aLl 6� �utA b� ��► Pt C )� me1 )i 11�a —G I� 7 PE A 1State License SLC License!RI yOriiginnall GC,subcontractor or owner/builder �— c'JS'CM C�� '�1 N�s� State LicenstC2Ce`�4{SLC License J New GC,.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 j contractor/subcontractor or cancellation of permit.A-permi not be cankedif k has been.performed.SIGNATURE OF OWNER(or owuer/builder) SIGNapplicable) PRIrdT NAME L(/Gdi'S P Q 4 G m PWNTNAME ? Stare of Florida,Cotmty of 5t-Pas+e Cotmty State of flosida,County of St Lucie County The lloning' c svlcdged before me this oltouiag insbn wa3 acimocried& before me this L.�c s - day of by da3'0f l� • t;2Q�bp_t C who )'s onally[mown to me ` fro is personally imoau to r' has prod •2 �•G-Hs 1D'' me or who induced as . 6 ��� 2�� e�� 1 ID l obi?AD26) Signature of P1ota Dote Signature of Notary Date A EVA WUNAR op Revi , ,_1§notary Public-State of Florida '° Notary Public.State of Floridaa4 6unnie Merritt Woodard e`- Commission 0 NH 42677 a My Commission HH 039826 My Comm.Expires Sep 26,2624 +? o4F' Expires 09107/2024 Bonded through National Notary Assn. OF 8 i 5i i _ I I 1 I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G Date: Permit Number: 000 O3(09 Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 I i PERMIT APPLICATION FOR: 00r PROPOSED IMPROVEMENT LOCATION: Address: fl2eK PL 2 195/ I Property Tax ID#: _50 - 0 - O"1 Lot No.55a Site Plan Name: e-S Block No. Project Name: DETAILED DESCRIPTION OF WORK: LL �S- S! I� I i New Electrical Meter Second Electrical Meter I CONSTRUCTION INFORMATION: i Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank —Gas Piping _Shutters X—I Windows/Doors _Pond Electric _Plumbing —Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: /0004 Sq. Ft. of First Floor: Cost of Construction: $ 1000`0 Utilities: _Sewer —Septic Building Height: a5 OWNER/LESSEE: CONTRACTOR: I Name G Name: RarrV Address: C (f, *- v Company• nS V City -M L /_�_ ('� _h State: Address: Zip Code: Fax: City: O L State:-f—'L Phone No. - - 5 w Zip Code: Fax: E-Mail: Luc a's � tMLy9G Gv'0u0,CQM Phone No Z- Fill in fee simple Title Holder on next page(if different E-Mail o affialC_Oz'Y1 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. i SUPPLEMENTAL CON UCTION LIEN LAW ORMATION: DESIGNER/ENGINEE _Not Appli le MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State:) Zip: Phone Zip: Phone: FE IMPLE TITLE HOLD _Not Applicable NDING COMPANY• _Not Applicable N me: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: I 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 Vi,,ktorneybefore commencing work or r prcli ng your tice of Commencement. r i Signature of ee rector as Agent for caner Signature Contra se older STATE OF FLORIDA STATE OF FLORID COUNTY OF COUNTY OF I Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of x Physical Presence or Online Notarization X Physical Presence or Online Notarization this day of (`�C_ 7 .2020 by this day of �fflh,P t� .2020 by i L Name of p rson makihd statement. Name of person maldnd statement. i Personally Known _OR Produced Identification Personally Known x OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary P blic-S ignature of Notary Public- e o t a +wcy Notary Public State of Florida y+►i+ Not ry Public State of Florida Commission No. ard g(� Merritt Woodard Bunme MerrittwoH 03 (ly`C�mm�ssion HFi 039826 mmission No. b Q fission HH 039826 ~'nor M10 Expires 0910712024 .i+or�o Exert p�e��9/0712024 I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. i i