HomeMy WebLinkAboutWS Lot 51 - Change of Contractor (2)PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
51
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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellationof the permit.
Date: (PVIQ IaCO4 Permit Number: 5&wll— c�M$'d—llp�j
Site Address* �I
�1waQ �i t•�tc State License SLC License
Original G , subcontractor ar owner/builder
L1► j)6gRDNI INrJC,4� impA.ICo State LicenseCaAOQ5J@,7 SLC License
New GC, subcontractor
Reason for Cancellation Non-Pertormance
The undersigned does hereby agree to indemnify and hold harmless
costs, fees or drages�risixgfrox� any and all claims of action for
contractor/ sytfcot for or cancel ation of permit. A permit canno
SIGNATU OFO or owner/builder) SIG
PRINT NAME Kevin Borkenhagen PRII
Slate of Florida, County of St. Lucie County
The following instniment was acknowledged hefom methis
r has produced es ID.
:�•^:••.; Irg�.EEN F.INGERSOLL
Signature of Nets ="".H=_
Commission #GG 149183
z;;o Expires November3,2021
aonded TMu Troyrain fnsuranca8
Revised 09/15
agents and employees fron
as a result of this change of
Jeffrey C. Lindstrom
State of Florida, County of St. Lucie County
The following inslmment vies acknowledged before me this
z� day of .um 2pz=,by +eemcwe,ua�
wh ersonall e�un to
me or o has pr uced as ID.
H: CQI2��?1
S(gnature of Notary Date
LISA GISBS
MY COMMISSIOPI tt GG 198165
EXPIRES:Aplil22,2022
.'f•?add�°�`� Bonded ThatWomry public Underwriters
All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (V o'i��% Permit Number: $ AMC;,
J
p i—
°° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential xxxxx
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578
PERMIT APPLICATION FOR:CIICIMAU Of CUHLIc`1ULU1 - FIVAC
Address:
Properly Tax ID q:1 711 � 1 W
Site Plan Name: Waterston Phase one
Project Name: Aspire At Waterstone
Change of Contractor -Non compliance
New Electrical Meter Second Electrical Meter
Addit/�ional work to be performed underthis permit— check all that apply:
VMechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $� A.
_Generator
Sq. Ft. of First Floor:
Lot No.
Block No. _2
_Windows/Doors _Pond
.Roof Pitch
Utilities: .Sewer _Septic Building Height:
0;
p � �C�SS�E
Name '+J"
Name: JeffreyC.Lindstrom
Address: 2%00
Company: Lindstrom Air Conditioning & Plumbing
City. ,mot
Zip Code: eSo Fax:
Phone No, Vat n 225g6
StateQd
Address:4290 SW Port Way
City: Palm City State: FI_
Zip Code: 33490 Fax:
Phone No 954-312-2963
E-Mail: OAL W LL ®K,.. 6J & d Qt"
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.
sS DPP SEMEN frALC01V�(yTRUCT1 N 1�,NjlAU1l jN50RfVlT QN
�-�i3�tE'!r�#s��ais.s'a14�-r'-.s"?��n.X.��;ta�a.
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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.
no
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit, I da 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
improvements to your property. A Notice of Comm
Lucie County an do rithe jobsite before the fi
with lender o n attoP v bef re commencing wort
Signature of Owr�yCessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF�vn
Sworn
to (or affirmed) and subscribed before me of
th14yk ay( ceor_Online0N;otabryzation
this�da of 2
K,a,�ui „nn BorkenhagOn
Name of person making statement.
Personally Known xv OR Produced Identification
Tvne of Identification
t may result in paying twice for
t be ecorded in the public records of at.
If yo/i iptVd to obtain financing, consult
Swo o (ar affirmed) and subscribed before me of
Physical Pres or Online Notarization
this day of, 111� _ 2021 by
Name of person making stat nt.
Personally Known ✓/OR Produced Identification
Type of Identification
Produced
(Signature of Notary P Iic;,Sta�e o�.���� INGERSOLL � (Signature of Notary Public4p �--tFlorid�a-) LISAGIBBS
mmi on GG 149103. MY�O ISSIOPI i. GG 198
Commission No, . j ea� Commission No. : a 1 ��
><pxes ove ber3, 2021 �,,.= v, F.S: April 22, 2022
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