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HomeMy WebLinkAboutHawley 2005 0330Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Fax 462-1578 CHANGE OF CONTRACTOR Or Subcontractor or Cancellation of Permit Change of Contractor is to be completed 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, signature, and transfer fee. 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. Subcontractor changes can be completed by the general contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the owner and qualifier of record. Date:� C LA acL:& Site Address: Permit Number: a Oa5 - o ?)3© ram/ 6a� cc �w( LL State License 3 SLC License OriginalGeneral Contractor (or Subcontractor) t�.A sibAL4,\ f � �(NQir\ State License L_ W`—(5 Lo SLC License New General Contractor (or Subcontractor) Reason for 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 andell 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..J Ai Z 19 S T F ER OMWe t!C SIGNATU OF -NEW GENERAL CONTRACTOR PRINT NAME vs 1 PRINT NAME M t C h OL Q State of Florida, County of St. Lucie County Tday \owing instrument was acknowledged before me this of , 20 ' by i_A h. ►.St a who is personally know tome ho has produce v`, Signat re of Notary Date yfor change of p din Stephanie S� HH 057731 S� d expo r2024 s as State of Florida, County of St. Lucie County The following instrument was acknowledged before me this day of 20 , bylL who is personally know to me o has produced as ID. S59n ate S ub C State of Florida Spurtin ort HH 05773172024 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1'�� Date: Permit Number: acas �4o L�1C�DC - o' if LnJ 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 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address Property Tax ID #: Site Plan Name: _ Project Name:i •- 53() -n o:-�';L -()C' n - DETAILED DESCRIPTION OF WORK: A��U ) 0 , C I cct-k�N New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: b k-, I Off' 3 Lot No.-3a - Block No. _ 3o-. 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: Cost of Construction: $ Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Nam Name:J'�ti; �� ' iL_l j C'k L'Y\(-I('\ Address Company: City:?C� -� Si l( luQ, Stater Address: C City: State: Zip Code: Fax: Phone No.771- S 1,J -S I Q Zip Code: ,_,3L( ( lk& \ Fax: E-Mail: Phone No 11;) - 4 L0 C, — I (,,Q S E-Mail s + Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County License con/ If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires. 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 Name: Address: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: BONDING COMPANY: Not Applicable Name: Address: City: Zip: Phone: City: 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 he jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attornefore commencing work or recording your Notice of Commencement. Signature Ow er/ Lessee/Contractor as Agent for Owner Signature of contractor/License Holder STATE OF FLO STATE OF FLO!n COUNTYOF �1— �C_.�t? COUNTYOF (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of korn sical Pres. nc or Online Notarization day of ��. 2020 by sical Pre ence or Online Notarization this day of 2020 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 Produced r c� ( 1 ' Kr n (Sig ure (Sig atu e f N rwgcw Ndary Public State of Florida Stephanie Spurtin Seal) Notary Pudic StetsJFlortdaCommissio Commission No. Ste hanieSpurtirHH 057 31 Expires 10/2712024 pmmrssiqt HH Expires 10/27/2024 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.