HomeMy WebLinkAboutWS Lot 17 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 V RGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
Lod- 1 `1
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 $50.00 fee for the Change of Sub"
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
I )ON o� -
Date: kip!jr ae�A Permit Number: �1.� QC>aa.
A Ow,Dk "AA
Site Address`: �5-,,`ti'.r?�
r�
State License SLC License
IOriginal G , subcontractor k owner/builder
I,1 QQ jftM Qc J G 4 t: L IPJ M& State LicenseCAMLULSLC License
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmles,
costs, fees or da ages S�j any and all claims of action for
contractor/s co3 for or cancellation of permit. A permit ennnt
SIGNATU OFO
orowner/builder)
SIG
PRINT NAME
Kevin
BOrkenhagen
PR
Slate of Florida, County of St. Lucie County
�T�hge foll�o�w�ing�in(s�tm�m,,en,,t7was acknowledged before me this
K Pvm 73tlP1r a by
has produced es ID,
Stgnaturc
�, agents and employees fron
as a result of this change of
new GC,
C. Lindstrom
State of Florida, County of St. Lucie County
The following instrmnent was acknowledged before me this
z< day of rung 20zJ by Jer�HC.IM,V an
wh ersonall efvnm to
me or o has produced lta s ID�I24I 2'
Signature of Notary Date I
'��'o`�Bonded Thm Tra Falnlnsuraooco 80Q3&5.7019I1 � ••,, LISAGIBBS
Revised 04/15 � •Ki iL
MY OOMMIS$IGN t`. GG 165105
`•, !e* EXPIRES: April22,2022
•'•;?;'oW Bonded ThrNatary Publicunde1writam
All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (34 QCY';I-� Permit Number: &,
T. L C I E
Building• • •
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential xxxxx
PERMIT APPLICATION FOR:Change of Conffc`aCto — HVAC
Address: 5
Property TaxlD#: 1711" IC.D^Vllpl
Site Plan Name: Waterston Phase one
Project Name: Aspire At Waterston
Change of Contractor- Non compliance
New Electrical Meter Second Electrical Meter
Lat No.
Block No.
Addityertal work to 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:
-��+: t:€'LESSE'Es.� xa
�..a"rPst.�s,��.CO•,N�`I'sF�+�
tQ�R:e�: ;'"3�-:+�'. �,��sr��'�.. r�
Name v114164
Name: Jeffrey C. Lindstrom
Address: ^
Company: Lindstrom Air Conditioning &
Plumbing
City
Zip Code: 06 Fax:
Phone No. VOA W45p3 � a
StateMIM
Address:4290 SW Port Way
City: Palm City
Zip Code: 33490 Fax:
Phone No954-312-2963
State: FI_
&Mall: L.L1G16420 ®k..%W •CQ"
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 at Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
xSGPP, fiMEN AL C®(�j eR'.i CST ®(V LIEN IA' INFOR'NI�
M. k/<z' 'ot,3i s k
A
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
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 Coi
improvements to your property. A Notice of Commern
Lucie County and d owe jobsite before the first
Signature of Owr�f/Cessee/Contractor as Agent
STATE OF FLORIDA
COUNTY OF
to (or affirmed) and subscribed before me of
��thi dayof 2
sicP ceor_OnlineRNAotbyzation
K,.,JkVin B0rkenhagen
Name of person making statement.
Personally Known � OR Produced Identification
Tvue of Identification
may result in paying twice for
be ecorded in the public records of at.
yo)�t iq VcI to obtain financing, consult
Swo o (or affirmed) and subscribed before me of
Physical Pres or_ Online Notarization
this day of (14(2020by
Name of person making stat nt.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary P lic;'Sta�e o - (Signature of Notary Pubiic� ��•"�'•"'�
;1,.r�••.,• L .INGERSOLL .� +.: o,; LISAGIBBS
:;= MY 0, ISSIOPI t. GG 198
Commission No, (� %Commission No. -• • e 122, 2022
a1 ;.•.,F r`oa,,; zpxes ber3,2021 : F.S: Apri
Bonded Tire TroyFaln lnsuraneam-�701 � P,°;Qc Boedod Yhrur;atnrypeblio Undow
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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