HomeMy WebLinkAboutWS Lot 40 - Change of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
W40
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.
:ax 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: set Ili Permit Number: OLN
Site Add5 S ^.,,'� A COS: "
�Q e? err- State License SLC License
Original G , subcontractor k owner/builder
bQJ)6Tfth Qt JC4/-YLIJfY aM& State LicenscC"E07SLC License
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harries,
costs, fees or da ages � gFretq any and all claims of action for
contractor/svecogir, for or cancellation of permit. A permit canny
SIGNATU OFO orowner/builder) SIGI
PRINT NAME Kevin Borkenhagen pR
Slate of Florida, County of St. Lucie County
�TZhe foll�o,,w,,ing in{stgtmgm,,e�nt7was acknowledged before me this
6,ViTi "tn6HHagtn--' by
Revised
Commission # GG 149183
Expires November 3, 2021
bonded Thru Trov Fain lasnra�n
�, agents and employees fron
as a result of this change of
new CC,
C. Lindstrom
State of Florida, County of St. Lucie County
The following instrmnent was acknowledged before me this
r+ day of � 20 aJ by r•e�.rc.umrum,
wh ersonell eim to
me or o hrpr aced as ID.
Signature of Notary Date
� lY GIBBS
'A1 ' MY COMMISSIOPI t6 GG 198105
EXPIRES: April223 2022
oFdnJad Thm Nolory Public Undenvrltare
All APPLICABLE INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��1 �c�-t
Date: W ask om% Permit Number: �_ C%Ica 'aszlc
O �� —
° °` �° ` ` 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:C
Address:
PropertyTaxlD#:
Site Plan Name: Waterstone Phase one
Project Name: Aspire At Waterstone
Chenge of Contractor- Non compliance
e of Contractor - HVAC
New Electrical Meter Second Electrical Meter
Lot No..�- o
Block No. 2—
Addit nal workto be performed underthis 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:
Name
"%6A1.LV.Name:
JeffreyC.Lindstrom
Address:: 40
Company: Lindstrom Air Conditioning & Plumbing
Zip Cod
Phone No.
06 Fax:
expt — ala542)
State
Address:4290 SW Port Way
City: Palm City State: FI_
Zip Code: 33490 Fax:
Phone No954312-2963
1 ' I
E-Mail:iZ.111Q6450 i 4DV, &0.0"
FIII in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Iisag@lindstromalr.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:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ict 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 Commencement m1bLst beVecorded in the public records of St.
Lucie County and paiapd of a jobsite before the first ins ection if yob ig Vcl to obtain financing, consult
STATE OF FLORIDA
COUNTY OF �a�.�r
Sw to for affirmed) and subscribed before me of
P sical P ce or Online Notarization
this day of t 1AE_ 20;4 by
,. ,"vin Borkenhagen
Name of person making statement.
Personally Known OR Produced Identification
Tvoe of Identification
of Notary
Commission
(or affirmed) and subscribed before me of
ical Pres or Online Notarization
day of IJWE 2024 by
Name of person making
Personally Known '� OR Produced Identification
Type of Identification
INGERSOLL � "'B"""
GG149183
iber3,2821 pyCommis.
Fain 1nsurance800.3M701UPERVISOY PLANS
of Notary Public�iito`iorrda�' LISAGBss
M���A1j�I5$IOM i. GG 198
r No. VI
iI ", 'ee E3: April22, 2022
�`SC¢F°c Oonaod'ihru t;n0uv t'n60c Ondory
REVIEWS I COUNTER I REVIEW I S REVIEW R I REVIEW I VREV EWON I S REV EWLE I MANGROVE