HomeMy WebLinkAboutWS Lot 43 - Change of ContractorPLANNING & 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
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
cancellationof the permit.
Date: (,ol 1r ]Iacq4 Permit Number: ti n_261O1'CcrJ
Site Address:
State License SLC License
Original 01, subcontractor k owner/builder
U WOSTROM \ J G 4: L IM M& State License fl 71 SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless
costs, fees or da tages�uscancellation
any and all claims erection for
contractor/syffcot 7t or or cancel ation of permit. A permit canno
SIGNATII GFO or ownertbuilder) SG
PRINT NAME Kevin Borkenhagen PRf
State of Florida, County of St Lucie County
The followingsin(sp�tm,, �ment wasacknowledged before me this
ag� by
.
lD
has produced as ,
SI naturcofNota :a^'`••.':, trfldOl.EENEINGERSOLI
�, agents and employees fron
as a result of this change of
new GC, es applicable)
C. Lindstrom
ty
Slate of Florida, County of 5t. Lucie Coun
The following instmment was acknowledged before me this
ze By Of +�+ 20 zJ by u•mac. umw.,.
wh ersonall ewn to
me or o has p need as ID.
�-r124l2
Signature of Notary Date
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aevised 04/15 � 80438570191) WI�LISAGIBBS
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_ MYCOMMISSION11GG19B765
EXPIRES: April 22, 2022
•y9l?^oai�°" BondedThruNoloryPu011c Unden"""
All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �G
Date: W a! 20rq-% Permit Number:15 D @`\O1 'cDo.�
° e 4.) �° ` `~ 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) 462-1578
PERMIT APPLICATION FOR:Change Ofi %aUHLIaCtOf — I'IVAC
Address:
Property Tax ID p:
Site Plan Name' Waterstone Phase one
Project Name: Aspire At waterstone
Change of Contractor- Non compliance
New Electrical Meter Second Electrtcal Meter
Additi nal workto be performed under this permit —check all that apply:
ymechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $rrr
Generator -
_
_Windows/Doors
Sq. Ft. of First floor:
_Roof
Block No. g5
_ Pond
Utilities: _Sewer _Septic Building Height:
Pitch
�
Name VII.J ftL
Name: Jeffrey C. Lindstrom
Address: 2 /�
Company: Lindstrom Air Conditioning & Plumbing
.t2,�� a
Cit� f �d�'�-- State �:l
Zip Code: 34�o Fax:
Phone No. ��0� e'1� 2'j
Address:4290 SW Port Way
City: Palm City State: FI_
Zip Code: 33490 Fax:
Phone No954-3t2-2963
1}�
E-Mall:i�rl�Gi6%(—W ®K ptp v.dC}:1
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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 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 Commenc ent may result in paying twice for
improvements to your property. A Notice of Commencernefit mlist beVecorded in the public records of St.
Lucie County and pasted 901be fobsite before the first ins ection If yo iVftd to obtain financing, consult
Signature
STATE OF FLORIDA
COUNTY OF �����
Sw9fn to (or affirmed) and subscribed before me of
'r/ Ph sical P Ps�Ice or Online Notarization
th�a day offJi tAW 20A by
K„ ,XQAn BorkenhagOn
Name of person making statement.
Personally Known OR Produced Identification
TVpe of Identification
(ar affirmed) and subscribed before me of
:ical Pres or Online Notarization
day of 1 J 202f by
Name of person making
Personally Known '� OR Produced Identification
Type of Identification
(Signature of Notary P nc;,.ataxe o �' Signature of Notary Public
�,.r.!�.••; � ,INGERSGLL � �; LISAGIBBS
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Commission No. i❑! Commission No. e 1
piresrN ber3,202i >&. uRfllkj: April 22,2022
tow`'• Bonded flu Troy Fain Insurance 800-385.70f y'`$t;°:0 Bonded Titre Notary POD Undon
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