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HomeMy WebLinkAboutChange of Contractor _ .. PLANNING & DEVELOPMENT SERVICES =£w '�;r:=`'�` BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: X_CHANGE OY 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: 1 -1d t Permit Number: a1 D U 7-' D Q Site Address: /a�/�� �� }d/� �.yce� � s>� 17� � I�L g `/qDy �1 Q,A�rL�/'�►� Q ,lpi�?.0� State License 'f.�C/o�6��o�7 $1C License Original GC,subcontractor or owner/builder . State License P_BC./a'�•�3� SLC License New GC,sl bcontracYbrv am,k (� Reason for Cancellation i I.C� cv�— The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all costs,fees or dama&eraRsmg from any and all claims of action for any reason,which may arise as a result of this change of contractor/subcon for cancellation of permit.A permit nnot be cancelled i ork has been performed. SIGNATURE F OwNER(or owner/builder) SIGMA CTOR or new applicable) PRINT NAME PRINT NAME State of Florida,County of St Lucie County State of Florida,County of St Lucie County Th llowing in eentt was acknowledged before me this Th llowing instrument was acknowledg efore me 's}y� —I7 n day of 20 by — � JJ c who is pe s nally known tome who i personally kno to or who has prod uc /(as ID. a or who has produced as ID. �-ern^ Signature of Notary Date Signature of Notary Date ,rs+► Notary Public State of Florida Revised 04/15/16 Bunnie Merritt Woodard N v My Commission HH 039826 Expires09107/2024 FLORIDA INDIVIDUAL ACKNOWLEDMENT F.S. 117.05(13)—Effective January 1, 2020 State of Florida County of St Lucie The foregoing instrument was acknowledged before me by means of ® Physical Presence ❑ O line Notarizat' this day of 2020 , by V i n G((� (Nrr of Perso cknowledgin ) (Signature of Notary Public—State of Florida) Shuntavious McNeil ;otY Pie , �SHUNTAVIOUS MCNEIL (Printed Name of Notary Public) Notary Public-State of Florida � o Commission N GG 921954 , My Comm.Expires Oct 21,2023 El Personally Known Ft Bonded through National Notary Assn. © Produced Identification Ty- of Identification Produced: (Place Notary Seal Stamp Above) �Y Description of Attached Document Complete this section to deter alteration of the document or fraudulent reattachment of this form to an unintended document. Title or Type of Document: cl)Goc� Document Date: I I�� 2020 Number of Pages of Original Document: Signer(s) Other Than Named Above (i.e.witnesses, minors, etc.): r All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ? Date: Permit Number: ae- �7- 0 a 16 • Building.Permit Application Planning and'DevelopmentServices Building and Code Regulation Division Commercial Residential Y 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 PERMIT APPLICATION FOR: PROPOSEQ-IMPROVEMENT LOCATION: Address: Property Tax 19#: yea'%gf;�A- Lot No. c;�a Site Plan Name: 10I Block No. Project Name: DETAIL_ED.DESCRIPTION`OF WORK: 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 _Electric _Plumbing rSprinklers Generator Roof Pitch. Total-Sq.Ft of Construction: Sq_Ft of FirstTloor: Cost of Construction:$ /9 D•00. ov Utilities: _Sewer- _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: Address• / ,?,? Company: City: -Stater Address:Q&* -9a�w Zip Code:. Fax: City: State: �L Phone No.;O,A l070 -elf 9Ilp Zip Code: . IIIIII 3 Fax: E-Mail:A(ATS11DT. ® ,yA1100 .e,aM_ Phone No r7a 3yo2-c2"7 Fill in fee simple Title Holder on next page(if different E-Mail )I b 0 o Y?s 7- MA 14- CO/0 from the Owner listed above) State or County Hcense ('W 1A S� 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. KI • SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: ,E. Name: Address: . o i yU Address: City: State: City: State: Zip:J2 o Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: X Not Applicable 130NDING COMPANY; Not Applicable Name: Name: Address: Address: City: Ciry: 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 germit holder to build the subject structure which is in cod ict with any applicable Home Owners Assodation rules,bylaws or and covenants that may restrict or prohibit such structure.Please consuitwith 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,wails,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 osted on the jobsite before the first inspection,If you intend to obtain financing,consult with lender or ri a nrnwtt before commencng work r recording o Notice of Commencement. Signature Owner)-Lessee/Contractor as Agent for Owner Signature STATE OF F D A► STATE OF FLORIDA C COUNTY �u� COUN�rYOF Sworn (or affirmed)and subscribed before me of S to for affirmed)and subscribed before me of 'Ica] Pres ce or Online Not�rization �Ph sicaI Presence or Online Notarization thi da of �( y 20�Jby thisdayof ®Prp .2Qe?-D by n Name of person making statement. Name of Verson m g statement. I Personally Known OR Produced identification I Personally Known ORProduced Identification Type of tde tion Type of Identification Prod cad ( V C' L_ Produced YA 9 MiL UAQ�baj Signature of Notary Public-S nature of Nota Public State o I r F SHUNTAVIOUS MCNEIL Commission No. ; ot����yy Public State of Flofid // ,y+P otary Public State of i a e( of�mmission#GG 921954 mmMon No. O p aP al unnie Merritt Woodar ar sk My Comm,Expires Oct 21,20 3 Q My Commission HH 0 9 .0 trirou h National Notary As n. +.f ° Expires 09/07/2024 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW RECEIVED DATE COMPLETED ev, JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY FILE # 4796919 OR BOOK 4528 PAGE 1128, Recorded 12/28/2020 10:15:21 AM NOT(CE OF COMMENCEMENT 4- Permit No.a2OD7- dR16 Tax Folio No yyaa s2;0C1-442 -6 O StateofFlorida County of StWae A •� The undersigned herebygFvas notieethat improvementwili be made to certain real property,and in accordancewjth Chapter713,Florida Statutes the following information is provided in this Notice of commencement. � � at address ifaval j QGeneral I.Criptionorlmprevement;_ g"Ll Y 4 V IV I Owner info ad I!or Less o rtlt;p motion if the Lessee contracted fortheImprovern I Name �PiI/YiYG {T Address la .2 t...Ph - U Interestinpnoperty_ Alte.J72_2AJ UName and addressoffeesimplett7iehoider(if different f listed above): 1 CbntraCtCr� N. Contr2dorAddre«-,V6 - Phone Number J9p� -?s��T m 3Se9s,3 Surety(if applicably a copy of the payment bond rs attached):Amnount of bond:$ Name and address: r1 •Phone number. Lender Name: /t�K Phone Number: Lender's address: 2 W Persons withtn theState of Florida designated byownerupon whom notices;or other documents may he served as provided by Section 1 713AS(11(a)7-Florida Statutes Name: Phone Number. M Address: MMIn addition to himself or herself,ownerdesigrates of to recelve a copy of the Vences Notice as provided in Section 718.13 1)ib)Florida Statute-'. MU Phone number of perm or entity designated by owner. W - Expiration date ref naUce of commencement (the expiration date may not be beforethe completion ofconstruction and final payment to the contractor,but will be 1 yearfromthe date of recoTdrng unless a different date is speeiHed) _ UWARNINGTO OWNFR:ANY PAYMENTS MADE BYTHE OWNER AFTERTHE EXPIRATION OFTHE NOTICE OF cammENCENIENTARE CONSIDERED 11,, 'IMPROPER PAYMENTS UNDER 03APTER 713.PART],SECTION 713.13,FLORIDA STATUTES AND PM RESULT IN YOUR PAYING TWICE-FOR I.L. IMPROVEMENTSTO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON TRE]OB SITE BEFORETHE FIRST INSPECTION.IFYOU INTENDTO C13TAIN FINANCING;CONSULT WITHYOUR LENDER ORAN ATTORNEY BEFORE COMMENCING WORK OR QRECORDING YOUR NOTICE OF COMMENCEMENT- Under penaltvcfpedu darethatI have read theforegorng notice ofcommencementandthatthefactsstatedtheraIn are truetothe best of my knowledge and eF - (Siggafi.m •OwneLar e,orOwnees ort—ee's Authorized Officer/Director/Partner/Manager LLMJ \ mW (Signator/STEtie/Office) _ STATE OF FLO A ` COUNTY OF i Ll.)•(� UThg foregIg in�tntm@gtw aci n viledged before me bymeans of p physical presence Wine notes' neon this day of D r(— Za---by t.e \j n 1Vl �/C+fl who rspemonalrylmownto ma orhas.produced r X 1 U �l as lden"Radon. �"^�`• SHUNTAVIOUS MCNEIL \L/^v � �_ Notary Public-State of FIor1Ea r r msson G 9Z7954 ` ''� �AEItAIa5EALleptres Oct 27,2023 Bonded through National Notary Assn. NOTARY PUBLIC,State of Florida V U IIIE:RERYCERnFYTIIAI'TIIISDOCUAIENI'IS,ITRUF.,I\DCORRECTCOPI.OFANOFFICI,\LRECORDOR 11"A,. Digitallyy siggned byy The Honorable Joseph E. Smith IIOCI)AIF.NTAUTIIORIZEDIIYL:\\VTORF,RECORDF.DORFILED:\\Il:\CTU,\I.IA•RECORDEDORFII,F.DI\ .� Date: 2020.12.28 10.16:13 -05.00 771E OFFICE OFIIIE ST.LUC'IE COUNTY CLEI1K OFTRE CIRCUrr COURT. L�i' TIIIS DOCUMENTALAY1L\VEItEDACTIO\SAS REQUIRED RS•G\V. Reason: Electronically Certified Copy VISIT IITTM','SrI.UCIF.CLERK.COAUSE.RVICES'F..CERIFY-OFFICIALRECORDS TO\:SI.10:RF.THIS DOCUMENT. .1" Location: 201 South Indian River Dr, Fort Pierce, FL 34950