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HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION RECEIVED 2300 VIRGINIA AVE FORT PIERCE, FL 34982 JUL 19 2021 (772) 462-1553 FAX 462-1578 SL Lucia County Permiftint, CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEAS ELECT 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. 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: /l �� I Z 1 Permit Number: 2 A b S 0006 Site Address: UV c�y , ,,, a � S b . r7 . ' ' �'�� e � �L 3 `�G y� State License SLC License Original GC, subcontractor or owner/builder 0560'5 9-14qg 4-- r e Pa,'C5 State Licensees 13 Z-2671 SLC License New GC, subcontractor Reason for Cancellation V f e_y; oo_s a of (ci d-, T 9 �.1 dk The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of contractor/subcontractorg�canceI ation ofpermit. A permit cannot be cancelled if work has been performed. IGNATURE OF OWNER (or owner/build�er)/ J SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) / PRINT NAME a V14/Z �� /7 CCI�CI s PRINT NAME Tt' f � "F � 5 C State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County The following ins met was acknowledged before me this U� �ay of JU � J 20? 1 by G VU WA who is pe sonally known to me or who r6 uced Ml�t�� ID. Signature of Notary Date The following inst ent was acknowledged before me this (b day of E-1 y 20_7_j by c1 V� CC. 1+0q_c�Pr-)�- whoivs er o' ally sown to /m ( has r,ducedP ' as ID. C L —� Signature of Notary Date Revised 04/15/16 NoWyPt�cStatnafFloride Melbsa MIS Crum MY Commission HH 99o739 j�,„, iExpiea osnen0z5 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number. / 9- gri. LL ort OPY7 +nkC_-11D AZI s .....�-_. ._ o:.•..— Building Permit Application Planning and Development Services FtE%RED Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 JUL 19 Phone: (772) 462-1553 Fax: (772) 462-1578 2021 St. Lucie Count PERMIT APPLICATION FOR: Permirrino ' ���� e Address: c�� f �� Lr� �-� • ,rya, �� 3���5 Property Tax ID #: 73)) " b 0 — Opq — poy —o Lot No. Site Plan Name: Block No. Project Name: - }����Gj►'' _ ram; I ( -�� n � 5 h �^ �� �-�, �� ��� �. ;�► � � New Electrical Meter Second Electrical Meter (Affidavit required) Additional 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 I Z Pitch Total Sq. Ft of Construction: 2-100 Sq. Ft. of First Floor: } Cost of Construction: $ A off. ©Q Utilities: _ Sewer _ Septic Building Height: Name 1�AV\ �irt"i�i! 5l Name: J C__y- Address: Company: C43 Ce'5 iGG �i!25 4- f W-'S�`/" City: V, �( State: icy Address: Zip Code: T4 cf_S" Fax: City: Ct dh CFe-1c� State: Phone No. %%�— `7G1 �// Zip Code:. ! / ttQ40 Fax: E-Mail: Phone No •777- 2YY - 3 c)`f o Fill in fee simple Title Holder on next page ( if different E-Mail _ from the Owner listed above) b or County LicenseC_,e-_G I3 MY 71 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: Not Applicable _ 2 MORTGAGE COMPANY: _ Not Applicable _ Name: Name: Address: Address: City: State: Zip: Phone- City: State: 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 Commencement may result in paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. nature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA r COUNTY OF 1.I�(�— Swor, tp (.affirmed) and subscribed b org me ofhysical Presence or Online Notarization this �day of ­t 20 zj by Name of person making statement. Personally Known O'R P ed Identification ( li �VL� p Identification Produced to--r5 -e- G L c, mAyi' \ (Signature of Notary Public- State of Florida ) Commission No. �T f (Seal) t�Aw � Notary public Stain or Florida Meli55a Goan V• MY Corrimis&bn HN 110731 p aI Expires 03/29/2025 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5 21