HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
aimBuilding & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor) is to be completed by the property owner, and the n w contractor of record for the
current permit. A new permit application must also be completed with new contractor information,
signature, and transfer fee. A new Notice of Commencement must be iled 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. Subcontractor changes car be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: I I G�
Site Address:
Original General
New Genial Contractor
Reason for Change
Permit Number
cb State License-- C
(or Subcontractor)
(or Subcontractor)
State
The undersigned does !hereby agree to indemnify and hold harmless St. ]
agents, and employees from all costs, fees, or damages arising from any
any reason, which maI arise as a result of this change of contractor/subc,
permit. A permit cannot be cancelled if work has been performed. a
SIGNATURE OF OWNER (c
PRINT NAME `"_
State of Florida, County of St.
The following instrument was
yo
or who h rod (,I
G6.+
icie County
knowledged before me this
by—d M�
li�op is personally know to me `
as
!
-M-14w(
SIGNATURE OF NEW GEP
PRINT NAME (
State of Florida, County of St.
Th� owing 'instrument was
or who
Signature o ry Date Signatu e f N tary
*Only si nature required for change of subcontra for
Revised 021/14
SLC License
.- SLC License
C
County, its officers,
all claims of action for
ctor or cancellation of
CONTRACTOR
_ n
County
)wledged before me this
by 1
is personally know to me
All APPLICABLE INTO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit umb r:
ILM IE
Building Permit Appli
Planning and Development Services
Building and Code Regulation) Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fay: (772)462-1578
in
t Sidential "
PERMIT APPLICATION
FOR:
ROVE
PROPOSED IMP{
ENT LOCATION t
;.,
Address: `}-U
Property Tax I D #:
Site Plan Name:
Project Name: C
New Electrical Meter
S
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $0 00 Utilities: —Sewer —SE
Lot No.
Block No.
ndows/Doors _ Pond
_ Roof Pitch
Building Height:
O:WN`ER/LESSEE,
[ '
i ." rt
CONTRACTOR,
Name
Address:
City: y ^I Qr'
Zip Code :3 {{I�
Phone No. �� �.
E-Mail:
Fill in fee simple Title Holder
from the Owner listed above)
Name:_ou
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County License3
�Y (� �l
State: f,
Fax:
U ` li
State:��
Fax: 11
on next page ( if different
tJ
If value of construction is 2500, or more, a RECORDED Notice of Commencement is regL
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
PRIMA:'
ON;
ON;T�UCTI(3N UEN L��IU — Applicable
m licable MORTGAGE COMPANY Not
DESIGNER/ENGINEER: Not App
Name:
Name: Address. State:
Address, State: _ City:
City: Zip: ____------ Phone
Zip: Phone _Not Applicable
FEE SIMPLE TITLE HOLDER:, Not Applicable BONDING COMPANY:
Name:
Name: Address:
Address: City:
City: Zip: hone
Zip: Phone: II
II'
AFFis hereby made to obtain a permit
OWNER/ CONTRACTOR IDVIT: Application to dot a work and installation as indicated.
issuance of a
I certify that no work or installatii n has commenced anting a permit will authorize the permit ho der to build the subject structure
St. Lucie County makes no re c able Homeowners Association rules, bylaws or and covenants restrictions t may restrict m prohibit such
ay
which conflicts with any app
structure. Please consult with your Homeowners Association and r� agree ee that I will our f rin all res e ts, perform the work
plans, the Florida Building Codes and St. Lucie County Amendments.
In consideration of the granting of this requested permit, I do hereby g
in accordance with the approvedroom
The following building permit applications are exe SPsigns,
i n screenom rgooms and accessory'uses t anooing a full concurrency review ther non-residential use
accessory structures, swimming pools, fences, walls, g
Commencement must be recorded in the public records
e rd cons
sult in paying twice or of St.
WARNING TO OWNER: Your failure t A Notice of Coe m Commencement may re tend to obtain
improvements to your property
Lucie County and posted on the �obsite before the first inspection. I you I
with len
der or an attorine before commend work or recordin our Notice of Commencement.
n n / _
5i ature of ner/ Lessee/
tractor as Agent for Owner
STATE OF FLORI"
COUNTY OF J Online Notarization
Sworn o (or affirm d an s bscribed before by
of
—� Physical Presence or
this j� day of `"�--'' J
��. Iw O /A.
Name of maKmwsLn
Personall now ORPr duce n e tification �_
Type of Ide Ificati n Prod , ced
Hanzc�vI
(Signatur No a Public- State of Florida) Kenny Public
Notary
(Seal) a -state of Florida
Commission 2' : Comm# HH087r07
s/N EA Expires 2/1/202
REVIEWS FRON j ZONING SUPERVISOR REVIEW PLANS RE EW V REVIEWION
COUNTER REVIEW
RECEIVED
COMP
SEATURTLE I MANGROVE
REVIEW REVIEW