HomeMy WebLinkAboutCHANGE OF CONTRACTOR, UPDATED PERMIT APPLICATIONPLANNING & DEVELOPMENT SERVICES4 - � . ` BUILDING dui 7GONffNG DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462---1553 FAX 462-� 578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
— i C 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
caneellation of the permit.
Date: $1-Wi Permit Number: 2t0(0- Oto(3
Site Address: lot 5 t3F_4-c 1a 4-v e
Original GC, subcontractor or owner/builder
State License
SLC License
f5vii-i—e �' �'n `t � �`t— State License 6C t Iai b 03k
New GC, subcontractorC License
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 aris' g from any and all claims of action for any reason, which may arise as a result of this change of
c J ctor/subcontracto ncellation of permit. A permit cannot be cancelled if work has been performed.
D
SIGNATURE OF OWNER (or o et/builder) SIGNATURE GENE CONTRACTOR (or new CC, as applicable)
PRINT NAME Ql IOCACZZI IF PRINT NAME 164r"' 1P4-r1e4t4-Z
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1day of V G uSr , 20,11 , by
D4✓i'S t N04a51f who is p sonall own to me
roduced as ID.
g12-7/)-
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1't day of AQ ICU Sr 20 Z I by
who is ersona known to
or who ha roduced as ID.
gIv/ z1
Signature of Notary Date
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/27/21
Permit Number:
L L Li, ALL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR:ELECTRIC
PROPOSED IMPROVEMENT LOCATION:
Address: 613 BEACH AVENUE
Property Tax ID #: 3419-510-0130-000-1
Site Plan Name:
INDARJIT Lot No.12
Project Name:
INDARJIT Block No. 14
DETAILED DESCRIPTION OF WORK:
REPLACE, LIKE FOR LIKE, 150 AMP METER MAIN AND 150 AMP PANEL, JOB WILL BE SCHEDULED W/FPL
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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
Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 180a. W Utilities
OWNER/LESSEE:
Name DAVE INDARJIT
Address:613 BEACH AVE
City: PORT ST LUCIE State: 1:1
Zip Code: 34952 Fax:
Phone No.754-246-1540
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sewer _ Septic Building Height:
CONTRACTOR:
Name:JOHN PANKRAZ
Company: ELITE ELECTRIC AND AIR
Address:1691 SW SOUTH MACEDO BLVD
City: PORT ST LUCIE State: FL
Zip Code: 34984 Fax: 772-340-3702
Phone No772-340-3797
E-Mail PERMIT@ELITEELECTRICANDAIR.COM
State or County License EC13006036
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: Not Applicable
DESIGNER/ENGINEER: Not Applicable
Name:
Name:
Address:
Address:
_
City:
City:
Zip: Phone: State:
_ State:
Zip: Phone
BONDING COMPANY: �c Not Applicable
FEE SIMPLE TITLE HOLDER: k 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 conflicts with any, applicable Homeowners Association rules, bylaws or and covenants that may restrict or
structure. Please consult with
prohibit such
your Homeowners 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 attorne before commencing work or recording our Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF_ Gr V V C 19
Sworn to (or affirmed) and subscribed before me of k Physical Presence or Online Notarization
this 1-7 day
of Aor, u 5r" , 20 ylby
3040 f'/hNictig2
Name of person making statement.
Personally Known _ C�_ OR Produced Identification
Type tification Produced
(Signatur o Notary Public- State of Florida)
Commission No. 66 IU(p S�� (Seal){ "'H=EIIAE ENAE DEWITTic — Stale of Floridaon
# GG 166915xpires Dec i0, 2021h National Nolary Assn.
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DATE
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