HomeMy WebLinkAboutWS Lot 46 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CIiANGE 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.
xxx 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
cancellationofthe permit.
Date: 1P1a*,�4 Permit Number: aoll
Site Address: 51(CA
�ptYle� �L+Wll1aQ le�w)44 e.� State License SLC License
Original G , subcontractor ar owner/builder
b Q9arRt)M N' G A; �Li 1plam o State Licenst(2AQ05-(fl7JLSLC License
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and bold harmless
costs, fees or d rages •' ' rgfie+p any and all claims of action for ;
contractor/s co or or cancellation of permit. A permit canno
SIGNATU GFO or owner/builder) SIG'
PRINT NAME Kevin Borkenhagen PRE
State of Florida, County of St. Lucie County
��Tzzhe foll��o��wyying ins�tm��m__e„„n[77.was aeknowledged hefore me this
6V1I1 B&Uyihagei `by
has produced as ID,
Signature ofNatant �"'•`A°'•`i'''+, KBbiI;EENEINGERSOLI
�, agents and employees from all
as a result of this change of
C, Lindstrom
State of Florida, County of St. Lucie County
The following instmmen[ was acknowledged before me this
se day of .um yp zr by �.raum.0
mw�
wh emonall eivn to
me or o has pro uced��_a
Signature of Notary Date '!
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Y,:c € EXPIRES: Apti122, 2022
Bonded Thnr Notory Pubile Underwdlets
All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tt �1
Date: � o'i4�% Permit Number:5k� aak �5 1
O
Building Permit Application
Pianning and Development Services
Building and Code Regulation Division Commercial Residential xxxxx
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624578
PERMIT APPLICATION FOR:C
Address:
Property Tax ID #: t �11 � (ZJG
Site Plan Name: Waterston Phase One
Project Name: Aspire AtWaterstone
Chenge of Contractor- Non compliance
of Contractor - HVAC
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator.
_
_Windows/Doors
Sq. Ft. of First Floor:
_Roof
No.
Black No.
Lot _
_
_ Pond
Utilities: _Sewer _Septic Building Height:
Pitch
�GO,�NT+�,
Name V►-1dR11S
Name: Jeffrey C. Lindstrom
Address: �LL%
Company: Lindstrom Air Conditioning & Plumbing
City. Cam-
Zip Code: .mot Fax:
Phone No, Vol � v1'a
StatePiid
Address:4290 SW Port Way
City: Palm City State: FI_
Zip Code: 33490 Fax:
Phone No 954-312-2963
E-Mail: �L1C�64-W 4DV I. i & 614C1'1i
Fill in fee simple Title Holder on next page
from the Owner listed above)
( if different
E-Mail lisag@lindstromair.com
State or County License CAC066971
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.
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: Not Applicable
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 ASSOCIatlon 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 Con
improvements to your property. A Notice of Commence
Lucie County an d o e jobsite before the first i
with lender o n att v be re commencine work or
as Aeent for Owner
STATE OF FLORIDA STATE
COUNTY OF �a�.m,„COON'
Swo n to (or affirmed) and subscribed before me of Swop
�P sical P ce or Online Notarization ✓ I
th- . day ciYf J aE- . 2q'4 by this 2
K,. J"yin Borke6agen CS
Name of person making statement. Name
Personally Known ..� OR Produced Identification
Tvoe of Identification
Notary
Commission
REVIEWS I FRONT
COUNTER
may result in paying twice for
be ecorded in the public records of St.
yo 1pp�nid to obtain financing, consult
yu NXICTof Commencement.
(or affirmed) and subscribed before me of
sical Pres or Online Notarization
day of►�— 2021 by
making
Personally Known '� OR Produced Identification
Type of Identification
Produced
e o " " j (Signature of Notary Pubiic� '""'""`"""
C .INGERSOLL t p �,.x �p�,: LISAGIBRS
mmi on GG 149183 I :i% M`[ d ISSIGNi. GG 198
ire i Commission No. �PI xpues o e ber3, 2021 a ES: April 22,2022
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ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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