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Home My WebLink AboutLauletta Change Of Contractor / BUILDING PERMIT APPLICATION _ - PLANNING & DEVELOPMENT SERVICES - BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR-OR CANCELLATION OF PERMT PLEA . SELECT ONE OF TH 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 till 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: Permit Number: v 6 - 0.) 6 /� ,L� Site Address: �� }.� t +.J P.Q e fd e k 6 �;3 pf'0 6r—OCM Cl1rJ�C4C�6 fS State License SLC License Original C'rC, s bcontractor or wner/bu'lder w�lv C4� Q . State License G 6C 65 7llicense c 02 9 Nets'GC, subcon tar Reason for Cancellation The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers,agents and employees tiatn all costs. fees or damages arising from any and all claims of action for any reason.wh may arise as result of his change at VNF ontr• Ercancellationof rmit. A permit cannot be a wo he n rfor etl.� for owner/builder) SIGNATUR' iEN L C'ONT CPOR for new C applicable) ?rtrrx A I ZV�� /�10.r J eC 1-au(eTTo-- PRINTNA ounty of state of Flonda,Counry of se..-bx w tnyA�._ Jm/,Y �A f 5 Ilowtnk t�n(wwmrnc uax at iatc,u led+Lr1- ti,rr•me th` llowkng utSrruttlettt was ae{Row[edged beforerrme this 'U ��] � 1� T[Y�w R Zhas �da}of�,Z'a'��] }by is personally Irnnwp to � wproducadUrrN °tart" ate ¢�1 KAREN L.BARKALOW O OS Notary Public.State of Flortda Commission M HH 102116 IR My Comm.Expires Mar 4,2025 ed through National Notary Assn, All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: L{ 1F-d I Permit Number: LL1C�LL =� Jf IF Building Permit Application Planning and Development5ervices Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax,(772)462-157 JIJ l N 1 PERMIT APPLICATION FOR: I°M p (� p,716 PROPOSED IMPROVEMENT LOCATION: - Address: �1 S Cr Property Tax lD#: d+- 11IS- 000E�- Lot No. r` Site Plan Name: Ct r b DU(' tIP p Block No. Project Name: DETAILED 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 S Plumbing _Sprinklers Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 60 6 . 0 Q Utilities: XSewer _ Septic Building Height: -OWNER/LESSEE: CONTRACTOR: --- Name-! I4N I 4 41"e� La czr Name: IN - _ Addresssps: 3 b City: IGi ►vl �' any: [IlJ UG LcFrU r T`� _ State. Address: e)I cS Zip Code: 3 �D Fax: City: 0 iil c f State: Phone No. �` 61 - 3 1 t -6 7 C]1 Zip Code: E-Mail: -�[C� �'r0. Fax: 77a - �np. � aAA Phone No 7 Fill in fee simple Title Holder on next page t if different E-Mail Vl� Q from the Owner listed above) State or County License CrsC o '7! S 6 F H 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 1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: QESIGNER/ENGINEER: �_ Not Applicable MORTGAGE COMPANY: i Not Applicable Name: Name:_ -- Address: Address: City: State: City: State: Zip: Phone Zip' _._ Phone: FEE SIMPLE TITLE HOLDER: 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. 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 Associations 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 fallowing 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-Dr a _attorney before commencin work or reqqrdiniz youtNotice of Co mencem t. i gna re Owner/Lessee/Contractor as Agent for Owner grikure Contractor/License Holder I STATE OF F*8RI A 14 L, STATE OF FLORID COUNTY OF MD6&Q If1 i COUNTY OF swot o(or affirmed)and subscribed before me of j &isRa� r af#irfsied and subscribed before me of Physical Prey ce or Online Notarization al Prese or Online Notarization 1F da of 20g(by + 246 ip(�� '0� _ `yrl nCOL.= u - 5`iai f,o perm ii Olt,ng s tement. Name of person mal ng statement. p*rsonally Kriawn OR Produced Identification Personally Known_ OR Produced Identificafin� ;_±ypc!,ofIdentific4ttcwi Npeo ldentification i-Froduced E,.a-n3tu, f t4ut-as:y Public Ste4e-eFfierfd`d) (Sigt4atu Ncitary Tubti[ FT KAREN L,BARKALOW Nat�P Ic-State of Rorida Commission No.` (Seal) Commission No. ' _ on k HH 102116 d ' fly Comm,Expires Mar 4,I025 Bonded through National Notary Assn, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE i MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPL€TED — .. ev.