HomeMy WebLinkAboutWS Lot 42 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(71A) 4ul-xoo3 FAX 462-I578
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.
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: (�OtQAV Permit Number: 5L. P.1.40):5
Site Address: 515� r'r`'^",",` " "�
lot
f �wae. � State License SLC License
Original G , subcontractor
�1.aoegftAA IG4—YLLtYUNKJ 0 State LicensdCAOZ _SLC License
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned
does hereby agree to indemnify and hold harmless SfLuck
County, its o
icers, agents and employees from all
costs, fees or d
ages rgf+erq any and all claims of action for a y reas
n, whic
m i
arise as a result of this change of
contractorls cogtr
or or cancellation of permit. A permit canno be can
elll i jvor
hayeeo-pec[ormed.
eRINT NAME Kevin Borkenhagen
State of Florida, County of S[. Lucie County
'Die following�i& nsin�im_en,,thwasaD�'(a�eknowledged befam me this
ISby
-
Signature
Revised
ID.
INGERSOLL
applicable)
C. Lindstrom
Slate of Florida, County of St. Lucie County
The following inslmment was acknowledged before me this
day of w^• 20=, by �•e,nc. rwumm
wh ersonall aivn to
me or ohaspr used as ID.
�- Cold?►
Sig nature of Notary onfe
,
Expires November32021 j
BOMed TMu Trayfaln lnsurancogp}3g5.7019 'e�I6�•,,, LISAGIBBS
,,`sKi4LY>rot
MY COMMISSIOPI t: GG 108165
..ioa EXPIRES:Apri122, 2022
All
ll1BondedThruNotary Publio Undem+ilea
All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c` A
Date: e�i�i � Permit Number: .]7W& QACA�C-83
ST. LUCIE
Building1 1 •
Plann(ng and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 4624578
Residential
xxxxx
PERMIT APPLICATION FOR:Change Ofi %njUHUaCt01 - Fivac
Address:
53
PropertyTaxlD#:t,7.11-` lC�)'QC`f�10'
Site Plan Name: Waterstone Phase One
Project Name: Aspire At Waterstone
Change of Contractor- Non compliance
New Electrical Meter Second Electrical Meter
Additi%nal work to be performed under this permit— check all that apply:
VMechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ ®'
Generator
_
Sq. Ft. of First Floor:
Block No. 3
Roof Pitch
Windows/Doors _Pond
_
Utilities: _Sewer _Septic Building Height:
NLn`R� $VSEEi���� ,. �
r�.h '��C�'S�[y��._s��4�`-i..�
C6� . �. a�iY3'+'lu�e�y
�`L.✓� 4.,�! 3•v. �a sae. �<��.?.t.`iYiSrP�AC�'��?� f? f k:
Name '%"%4111
Name: Jeffrey 0. Lindstrom
Address: 2601 Q■!
Company: Lindstrom Air Conditioning & Plumbing
City. L- State:Cr:1164
Zip Code: c;o Fax:
Phone No. VOA -=6l
Address:4290 SW Port Way
City: Palm City State: FI_
Zip Code: 33490 Fax:
Phone No954-312-2963
1 ' I
E-Mall:�111GiOJIL30 ®�-%6J 614V"
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail lisag@lindstromair.com
State or County License CAC056971
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.
,��LE��N�rt� ��;SR;:•Ts�.��N��R'.IVI,�
TION.:� � �������`������`��,����"�
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 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 Con
improvements to your property. A Notice of Commence
Lucie County an d ore jobsite before the first i
with lender o n attow �v before commencine work or
as Agent for Owner
STATE OF FLORIDA
COUNTY OF �.�a
Sw to (or affirmed) and subscribed before me of
P sical P ce or Online Notarization
t is � day of�lril.lf� 20A by
K,�;,B, "Vin Borkenhagen
Name of person making statement.
Personally Known_ OR Produced Identification
Tvoe of Identification
Commission No.
INGERSOLL
GG 149183
iber3,2021
STATE
t may result in paying twice for
t be yyecorded in the public records of St.
If yob (atttnd to obtain financing, consult
(or affirmed) and subscribed before me of
sical Pres or Online Notarization
day of lJ► , 2020 by
Name of person making
Personally Known
4,. .., a,; LISAGI66S
MYy[E;0gM� ISSIOPI lkGG 79S
i No,
it i �,: _ LXPl ES: April 22,2022
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