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Home My WebLink AboutChange of Contractor V/1" _ PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION RECEIVED 0 0 2300 VIRGINIA AVE MAR.01 2021 FORT.PIERCE, FL 34982 Permitting Department (772) 462-1553 FAX 462-1578 St. Lucie County CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT 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: _ 2- 1 IS 12-Q>Q Permit Number: a06 Site Address: .?y 9y ( 2ly �. 4Z >04AZW JCO&��j State License C414a A0 SLC License Original GC,subcontractor or owner/builder State License CBG/adrSIAl SLC License New GC,Yubcon4aStor 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 contractor ntractor or cancellation of permit.A permit cannot be cane ed if work has been performed. SIGN TURE OF OWNER(or owner/builder) SIGNA p C�(�� ,as applicable) PRINT NAME LA41r,4 PRINT NAM 2�F't�—F"1 E "tL—I_L� I Iv State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County ir= instrument-was acknowledge before me thi The following ins ent was ac owle ed before me this 141 -20?1 by O�j daY oYU— f A O ,by Crn who is personally known to me who is ersonaily kno to or ho as produced} V V& V e-'•as or 94 has produced as ID. Si of Notary Date Signature of Notary Date '" 1Yp"" �,Y I(L_ Notary public State of Florida Revised 0 /•• G? JASMINE H COBB f3unme Merritt Woodard Q; Notary Public-State of Florida a My COMM15s10n HH o39826 'oF v� �° Expres o910712024 ','� o° Commission,#GG 230673 My Comm.Expires Jun 20,2022 t - All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .Date: Permit Number: RECEIVED MAR 01 2011 • Permitting Department Building:Permit Application 5t. Lucie County Planning dribevelopmentServlces Building and Code Regulation Division Commercial Residential X 2300 Vrginia Avenue,Fort.Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 PERMIT APPLICATION FOR: PROPOSED-IMPROVEMENT LOCATION: Address: SO 95/ p9(, wta.)dpt Property Tax ID-#: /`l 0- O 1040145A dOd- Lot No. Site Plan Name: A%ea�*, C0.94 0 &4)� Block No.3 Project Name: r D.ETAI LED-DESCRIPTION--OF WORK: 011 x io New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed ubder 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: Sq_Ft.of F{rstfloor: Cost of Construction:$ , d00. " Utilities: _Sewer _Septic Building Height: OWNER/_LESSEE: CONTRACTOR: Namee�+ B�LdI�_uy &ASA- .� Name• -� '�.uu� � ,G Coy Address: Oa _Company: City: 'r—t -State:� Address:Q7 '90 �� .z Zip Code:,W4//V — Fax: City: &vg�6t&(,a ] State Phone No. 7,7 oZ/.. qzlgr zip Code:S'lMlY Fax. E-Mail:d&PP h o/®Y2&TgjL y goof Phone No VA '911/a- A4r8 7 --- - Fill in fee simple Title Holder on next page(if different. E-Mai{ h bG O from the Owner listed above) State or County License a i if value at construction is Z500 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: UtblCOName: I ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable Name: E pP �' Name: Address:sib/ yyJ e?yp Address: City: State: rG City: State- Zip: o Phone $/ - O Zip: Phone: FEE SIMPLE TITLEHOLDER! Z 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 Assoclation 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,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 posted on the jobsite before the first inspection. If you intend to obtain financing,consult _ with Iendgforanattorner before-commencing work or recording our Notice of Commencement. v Signature o eelcontractbr as Agen r owner Signatur er STATE OF FLORID STATE OF FLORIDA COUNTYOE . FT Lytc,c a COUNTY OF ST L Sworn to(or affirmed)and subscribed before me of SwW to or affirmed)and subscribed before me of Physical Presence or Online Notarization t"PhysicaI Presence or Online;Notarization th1s21dayof I 20 by this day of 2Q� by t TiI 2 M 9 -9 f ' Name of p n makidghtatemenL Name of per n maki tement. Personally Known_Q OR Produced Identification Personally Known ("�O OR Produced Identification Type of Identification Type of Identification Produced Produced C {Signature of Notary Public-Stat �y' 0r r Notary tore of Notary Public-5 to for TTo ary Public Slate of Florida Public state of F.I rl .g unnre Masi Woodard y� Bunnie Merntt Woodard Commission No. lily Commission HH 039 tom i5sll)n NO. �f ,p Q ff��gg@g{�missron HN 039826 iy �o Expires 09107/2024 dv expires 09/07/2024 Porn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE DATE COUNTER REVIEW REVIEW REVIEW REVIEW" REVIEW REVIEW RECEIVED DATE COMPLETED ev.