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HomeMy WebLinkAboutWS Lot 39 - Change of ContractorPLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 4624553 FAX 4624578 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: llo j ) Permit Number: fl am OI Site Address: �YLI� litq ;� �. y.� State License SLC License Original G , subcontractor rroowner/builder bQ()Ji(tM NJCA;� Lilariameo State License LSLCLicense New GC, subcontractor Reason for Cancellation Non -Performance The undersigned does hereby agree to indemnify and hold harmless S Luc County, its o tcers, agents and employees from all costs, fees or d rages ' ' tgfieal any and all claims of action fora y reas n, whi�ma arise as a result of this change of contractor/sueeo or or cancellation of permit. A permit cannof be can elly)1' jvor hayaen1mr1ormed. SIGNATU OFR� OWI�GR'torowner/builder) PRINT NAME Kevin Borkenhagen Slate of Florida, County of S[. Lucie County 'Izzh44e foll``'oAA;w��ing insUtr�um_ent�waaas��acknowledged before me this &VIII S UWMge& =by has produced as ID, Stgnature ofNota :'�,`•"•"'�`�ti=. MWEENF.INGERSOLL Commission q GG 149183 e` FxpiresNovember3,2021 Booded Thru TroyFa(ntnsumacaa Revised 09/15 applicable) C. Lindstrom Slate of Florida, County of St. Lucie County 'Che following instmment was acknowlcdged before me this z+ day of �+�^ 20 zJ by wb ersonall efm to me or pbo, has pro ucedas IDOhI � 1 Signature of Notary C Date �`��LISAGIBBS _ , MY COMMISSIONt:GG108105 ce EXPIRES: Ppril22, 2022 •j',' BondedThn•Nolory PuhlicU�eiwdlare `= _ All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (y a! Permit Number::5L%so �Mro LOUIE Q0. o, •.3 n p. 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:Chan Address: �: �► of Contractor - HVAC PropertyTaxlDff: Site Plan Name: Waters[one Phase one Project Name: Aspire AtWaterstone Chenge of Contractor- Non compliance New Electrical Meter Second Electrical Meter Additi al workto be performed under this permit —check all that apply: chanicai _Gas Tank _Gas Piping _Electric _Plumbing _Sprinklers Total Sq. Ft of Construction:' Cost of Construction: $ Lot No, 3�1 Block No. �J _Shutters _Windows/Doors _Pond _ Generator. _ Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: Op OWNER s"NER� SSkE�E�����_� � n�k "Py �C��.�,� Name V%40v11L Name: Jeffrey C. Lindstrom Address: Company: Lindstrom Air Conditioning & Plumbing Zip Code: Phone No. State:�lq 2S05406 Fax: VOA W0558 — oww Address:4290 SW Port Way City: Palm City State: FI_ Zip Code; 33490 Fax: Phone No954-312-2963 &Mall:kLLlLitX+ 20U 41DY +%6j&64CW 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. PCnN�ISR'�CrT1©NL�N3�LAWsINOR(VITiIQN DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE Name: HOLDER: Not Applicable BONDING Name: COMPANY: Not Applicable Address: Address: City: City: Zip; Phone: Zip: Phone: WW OWNER/ CONTRACTOR AFFIDVIT: 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 County makes no representation that is granting a ppermit 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 •��•�• Sw to (or affirmed) and of� subscribed before me of P srcal PJ�5e1�ce or Online Notarization thisan day 20e4 by K,.uin Borkenhagen Name of person making statement. Personally Known OR Produced Identification TVDe of Identification may result in paying twice for Swo o (or affirmed) and subscribed before me of Physical Pres or Online Notarization this1 day of IJ►E 2020by Nameofperson makingstat4y nt. Personally Known ✓/OR Produced Identification Type of Identification (Signature of Notary P Iic;,StaJ;e o��C�jF. INGERSOLL `.� (Signature of Notary Publics --- —'�' mmi on GG 149183 -x. '�M 0 ISSlONf0 GG 198 Commission No. e� Commission No. =rR pees oe ber 3, 2021 �P% �- ES: Aprll22, 2B22 ` Bonded Thu Troy Fain hSaranC8800-�7d1 ' O" Bondod'rhru r,�uny Publlo Undon REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW