HomeMy WebLinkAboutchange of contractorPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
s ' Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Pe
Change of Contractor is to be completed by the property owner, and the n
current permit. Anew permit application must also be completed witt
signature, and transfer fee. A new Notice of Commencement must be i
name for job values greater than $2,500 ($7,500 if A/C Change -out)
submitted prior to commencing any work. Subcontractor changes can
contractor. Absent extenuating circumstances, a cancellation of permit
owner and qualifier of record.
w contractor of record for the
new contractor information,
led in the new contractor's
A recorded copy must be
be completed by the general
s to be executed by both the
-
Date: � - � � 2 Permit Number• 210 � J,-,
Site Addr ss: � � ` �/ f W— -
a
State License �C � 3 12 SLC License
Original General Contractor (or Subcontractor)
e-09A, VYA660 State LicenseC(Sc-D10L-_�SLC License
New Genera Contracto Subcontractor)
Reason for Change
I
The undersigned does
agents, and employee;
any reason, which ma;
permit. A permit cann
SIGNXTURE OF OWNER (or
PRINT NAME k
State of Florida, County of St. P
The following instrument was a _
or who Aas pAuced U. LQr
Signatu of Notary
*Only signature r,
Revised 07/21/14
lereby agree to indemnify and hold harmless St. L ie County, its officers,
from all costs, fees, or damages arising from any aid all claims of action for
arise as a result of this change of contractor/subcon actor or cancellation of
t be cancelled if work has been peirf9,rmed. /
County
iwledged before me this
1 by -_ v
s personally know to me
asID. i
PRINT
State of Florida, County of St.
YThe wing instrument was
day f_,
or
Date ' --&VpaJ1reof Notary
aired for change of subcont actor
County ,
wledged before me this
.by "-D
s personally know)to me
Date
All APPLICABLE INFO MUST BIE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Numbe
L CIE
a Building Permit Applic;at
Planning P and Development ices
Building and Code Regulation Division Commercial f
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
idential X
PERMIT APPLICATION'iFOR:
R'E-ROOF
IPD i 1 ® � l
W. k �iF
Lk
Address: 159 PEPPER LANE�I
Property Tax ID #: 4511-503-0008-000-1
Site Plan Name:
Project Name: TED DURIG
REMOVE EXISTING TILE ROOF
APPLY POLTSTICK TU-MAX DIRECT TO DECK
INSTALL BORAL LIFETIME TILE ROOF SYSTEM
New Electrical Meter Second Electrical Meter
Lot No.2
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ indows/Doors _ Pond
_ Electric _ Plu bing _ Sprinklers _ Generator Roof 6/12 Pitch
Total Sq. Ft of Construction: 25 SQ Sq. Ft. of First Floor:
Cost of Construction: $ 30,000 Utilities: _ Sewer _Septic Building Height:
NameTED DURIG
I (va t4ae,
Company:M - RO(
Address:159 PEPPER LANE
Stater
City: JENSEN BEACH
Address:861 SW LAKE
Zip Code: 34957
Fax:
City: PORT SAINT LUC
Phone No.631-935-4151
Zip Code: 34983
Phone N0772-897-248!
E-Mail MARZOROOFIN
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed abo e)
State or County License
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.
NGINC
iRST DRIVE
State: FL
Fax:
INC@GMAIL.COM
CC1331207
a Ail,
PPLEME TAIL►
TR�I�T'0�1
LI MgtfFI®R
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone II
II'
Not Applicable
MORTGAGE COMPA
Name:
Address:
City:
Zip: Phone:
I
Y: _ Not Applicable
State:
State:
FEE SIMPLE TITLE HOLDEht;
Name:
Address:
city:
Zip: Phone:
I'
Not Applicable
BONDING COMPANY
Name:
Address:
City:
Zip: I Phone:
I
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to c
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no repro) entation that is granting a permit will authorize the permit
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants
structure. Please consult with your Homeowners Association and review your deed for any r
In consideration of the granting of this requested permit, I do hereby agree that I will, in all r
in accordance with the approved Plans, the Florida Building Codes and St. Lucie CountylAme
The following building permit ap
accessory structures, swimming)
WARNING TO OWNER: Yogi
improvements to your
Lucie County and poste
with Ipndpr nr an atton
the work and installation as indicated.
to build the subject structure
ay restrict or prohibit such
ons which may apply.
pects, perform the work
ments.
onsare exempt from undergoing a full concurrency revew: room additions,
fences, walls, signs, screen rooms and accessoryi uses t another non-residential use
r failure to Record a Notice of Commencement may re ult in paying twice for
)roperty. A Notice of Commencement must be rec rded in the public records of St.
i on the jobsite before the first inspection. If you in end to obtain financing, consult
ev hpforp commencing work or recording vour Notice of Commencement.
A
tractor as Agent for Owner
caner/ Lessee/Co
STATE OF
OF FLORIDA
COUNTY
Swor to (or affirmed) and subscribed
before me of Physical Presence or
Online Notarization
this day of
20�JL by
C_A
Name of p rsokt�ia 'n atement.
Personally Kno OR
Produced Identification
Type of IdentifP duced
(Sign ure of a Public- State
of Florida)
Commission No.
(Seal) APARY Kenny Hanzow
c� a Notary Public
' State of Florida
r
w = Comm# HH08766?
114CE TI 02F
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DATE
RECEIVED
DATE
COMPLETED
rcev 5/ cu/ c.L