HomeMy WebLinkAboutWS Lot 44 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578 ',l1
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 R $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: W1��' � , Permit Number: ,lot
Site Address:it
�r�- 1 � State License SLC License
1Original GO, subcoontraacttoorIrrowner/builder
l %a()eFFfftM N IG4ro-ILL lWV&M& State LicensJCAO�6Lfl/71 SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold hannles
costs, fees or d [ages � ingfre+q any and all claims of action for
contractor/s cot r< or or cancellation of permit. A permit can
SIGNATU OFO orowner/builder) SIG!
PRINT NAME Kevin Borkenhagen PR
State of Florida, County of St. Lucie County
The following instmment was acknowledged before me this
agents and employees tton
as a result of this change of
new GC, es applicable)
Jeffrey C. Lindstrom
State of Florida, Ceunty of St. Lucie County
The following inslmment was acknowledged before me this
z+ day of h^+ 20 z.�by .xnyc.um.wm
wh ersonall oim to
'e orgoh+pr need ��to 6 a�Ol�"I�1
S(gnature[offNNotary Date T—r1
�ISAGISBS
MY COMMISSION t: GG 105705
EXPIRES: April 22, 2022
•)'•"•'„+•,'odi °.`•`` uondM Tin, Nalary PublloUndo mdters
All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A �`
Date: (Oka ��% Permit Number: %boo t%16
..LWCIE
CO-T'.Y..- -rr
R'' 1 0 I
BuildingApplication
Plann(ng and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624578
Residential xxxxx
PERMIT APPLICATION FOR: Change Ul Contractor - HOC
Address: rJ1IDIM
Property Tax ID#:
Site Plan Name• Waterstone Phase One
Project Name; Aspire At Waterstone
Change of Contractor- Non compliance
New Electrical Meter Second Electrical Meter
Block No. 0?)—
Additio al 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:
Cost
$
of Construction:
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
® rNEt S1SEEs
Name V%4 V*vL
Name: Jeffrey C. Lindstrom
Address:
Company: Lindstrom Air Conditioning & Plumbing
City.
Zip Code: Fax:
Phone No. oUOi —ela
r�-y�
State;H:"l
Address:4290 SW Port Way
City: Palm City State; Fit
Zip Code: 33490 Fax:
Phone No954-312-2963
l 1 -
E-Mall:iL111Q&%LW 4DYJAwst640t 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.
a,
PENTgLCONSTRiCTI®TNIIAW41N50RMNY:y�4k�XQ 41Fs
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
as Agent for Owner
STATE OF FLORIDA
COUNTY OF a��
Swatn to (or affirmed) ans n d subscribed before me of
Y P srcal Poser ce or Online Notarization
thiday of JAAAd 20J4 by
K,.a>YdSlin Borkenhagen
Name of person making statement.
t may result in paying twice for
Na
(Signature of Notary Pu IIc;,State o��C�1�, INGERSOLL ',�lSignature of Notary Publics � uSAGIaB9 ?� �a P•gyfi,,
�9mmil��. lon GG 149183 ��'`�t MISCOdd�j ISS10P1 ikGG 198
Commission No. Expires`No3�ei ber312021 Commission No, •A e.XpI E:+: April22, 2022
Bonded Thru Troy Fain lnsuranmsoo,3w7ol `:°I;P:°c' Bonded Thru tloroiy Pubno Undon
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