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HomeMy WebLinkAboutChange of ContractorRECEIVED PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION MAY' 21-2021 2300 VIRGINIA AVE permitting Department FORT PIERCE, FL 34982 St. Lucie C:Ounty (772) 462-1553 FAX 462-1578 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. 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: Permit Number: l _6 b (e — ©� 1 g Site Address: _5 z4a GY%6—b' S State License SLC License Original GC, subcontractor or owner/builder ­4-- tT'S r State License I% (9 �v SLC License New GC, bcontractor A Reason for Cancellation 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/sd �Ontractorr7// cellation of perm' . A permit cannot be can le' ' work has been performed. / I , // SIGNATf)ki`OF OWNER (or ownei/builder) SIGNATLWGENEgAL CONTRACTOR (or new GC, as applicable) PRINT NAME,7C&1Ph 0`. S ' �t11G,k PRINT NAME_ �D%� (r-eo rg 2 1:4 d .'CA State of Florida, County of The following instrument was acknowledged before me this 1-day ofI 61-), 20 2A, by who ispecsonally known to me ?who has pro uced sID. ature of Notary Date a o% QJ q.% Z : a~ t r State of Florida, County of St.-6aeie.C.eua4y The following instrument was acknowledged before me this day of 20_, by T O h ^ &e? O ` !3 who is personally known to me or who h s produced as ID. L—o� 0 S ,2Z. ignature of Notary Date ;otigYPtiBG, JONATHAN DREXFORD :? - n'- �r Notary Public �' c` Commission N '9'koF�' My Comm. Expirded Bonded through Natio. Revised 04/15/16 REXFORD Notate of Florida E!Bon GG 948388 =National Mys Apr 19, 2024 al Notary Assn. ill APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED P Di Date: Permit Number: 6 [ j to -,7 q &_ Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial </ Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: RECEIVED . MAY`.21._ 2021 Permitting Department St. Lucie County Address: J ?1 VF Property Tax ID #:I q 07,(5DL7j c90 0 ©DO Lot No. New Electrical Meter Second Electrical Meter Additional work to be performed under this permit — check all that apply: _Mechanical _ Gas Tank —Gas Piping _ Shutters Widows/Doors _ Pond Electric _ Plumbing _ Sprinklers _ Generator Hof �laZ Pitch Total Sq. Ft of Construction: i® p D, Sq. Ft. of First Floor: ' dG Cost` of Construction:$ elyl *ep ` Utilities: _Sewer _Septic Building Height: 01NNERJLE�S�S i*: CDNTFtACTOR: Name Name: 4 ssz, Ce Address: G' �i{ S -fi�v2'�.�,� Company:. e rg v_ City: r'� ` e ce -e_ L State:- Zip Code: Fax: Phone No. Address:hZl Old d /.c, e �wY City: Zip Code: -3d 16 z Phone No 72244 Late: Fax: Y'P I(e E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail 1 State or County License 6C l J,3J loZ 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. PPLEMENT L C«taNSTRUCTION LIEN LAWM TION,ESIGNER/ENGINEER: Not Applicable ame: rOL' �-1-e r- I MORTGAGE COMPANY: mot Applicable Name: Address: P�r>=r- Pa rfc ol�r`��^ Address:. City: Xi 02e ,--c,� State: C-4. Zip: Phone J7 2 2 0 City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: at -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 C unty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with I der or an attorne before commencing work or recording our Notice of Commencement. J . A Sign re of Owne essee/Contractor as Agent for Owner Si ture of Contractor/License Holder ST TE OF FLORIDA COUNTY OF 1,Adiq n {L;ve,r STATE OF FLORIDA COUNTY OF 1AA hf,, 9 %I'c' Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization q' this � day of A)CkY 2QZJ by Sworn to (or affirmed) and subscribed before me of 1*15h-ysical Presence or Online Notarization this-V day of "Y 240021 by wCC- Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known P"-- OR Produced Identification Type of Identification Type of Identification Produced Produced ignature of Notary ubli ` FlpblA9 Oublic - State of Florida =�` Commission # GG 948388 et 20( . e� Commission No. U�>v4F°' My�I)ExpiresApr 19, 2024 Bonded trough National Notary Assn. iq "INBonded ignature of Notary Publi 5..._FloridgTHAN D REXFORD °?; �� �= Notary Public - State of Florida �yy �' o: Co�}i[nrtiss n # GG 948388 Commission No. 3�� ''F op_ My Cotnl���iresApr 19, 2024 through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 5/6/20