HomeMy WebLinkAboutWS Lot 20 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
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
cancellation of the permit.
Date: VJ aV6 i Permit Number: —mXA:_ c:;#+w 'WIF
Site Address:
U
EWiI�lA1.Li � %N�30 T v^ State License SLC License
Original G , subcontractor &r owner/builder
bQpe;'ftM r\'G4�Lil iumo State Licenst/���Q_SLCLicense
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless
costs, fees or d< ages 1 i�fee� any and all claims of action for
contractor/ s cot or or cancellation of permit. A permit canno
SIGNATU OFO or owner/builder) SIG
PRINT NAME Kevin BOrkenhagen PRI
Slate of Florida, County of St. Lucie County
EINGERSGLL
agents and employees frog
as a result of this change of
Jeffrey C. Lindstrom
ty
Slate of Florida, County of St. Lucie Coun
The following instminent was acknowledged before me this
r4 day of +++ 20 a� ,by Lffatw. nw�,
wh ersonell eiun to
me or o has pr need - lasrrD.
Signature of Notary Date
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Revised 09/15 i�rr,'r,'u4n,,
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,co EXPIRES: Aptil22, 2022
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All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��1 rr��
Date: � ask `�.% Permit Number: �n E oil C2 "u�6ej
c) o Su60L I� g ,
Fir
°A'° ..n Y Building Permit Application
Planning 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:
PropertyTaxlD#:
Site Plan Name: Waterston Phase one
Protect Name: Aspire At Waterstonc
Change of Contractor- Non compliance
e of Contractor - HVAC
New Electrical Meter Second Electrical
Lot No.
Block No. 3
Additio I workto 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: Sq. Ft. of First Floor:
Cost of Construction: $ -�� Utilities: _Sewer _ Septic Building Height: ff
ai
OVY�i�I�������;��
,'�O�NTR�4CR��,��;��
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.
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I WIN IN, 44
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT0 Application is hereby made to obtain a permit to do the work and Installation as Indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count 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 Cot
as
STATE OF FLORIDA
COUNTY OF ��
Swo o (or affirmed) and subscribed before me of
sicPfpCatice�Onlinezation
this day o`f� 2
0J4by
t may result in paying twice for
(or affirmed) and subscribed before me of
steal Pres or Online Notarization
day of N IJ2024 by
„,mauin Borkenhagen
Name of person making statement. Name of person making
Personally Known 'J***� OR Produced Identification Personally Known � OR Produced Identification
T e of Identification Type of Identification -
Pro ced Produced
(Signature of Notary Pllc-'011,e o (Sf nature of Notary Public IV[ lud
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