HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building &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 new contractor of record for the
current permit. A nev�':permit application must also be completed with new contractor information,
signature, and transfer fee. A new Notice of Commencement must be fed in the new contractor's
name for job values greater than $2,500 ($7,500 if A/C Changeout). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent exlienuating circumstances, a cancellation of permit i to be executed by both the
owner and qualifier of record.
Date: vll Permit Number:
Site Address:
c �D I 4 CQ-�'—IJi State Licensee
Original General Contractor (or Subcontractor)
State Licens L
New General Contractor (or Subcontractor)
i
Reason for Change
II' I
The undersigned does Hereby agree to indemnify and hold harmless St. Lt
agents, and employees from all costs, fees, or damages arising from any as
any reason, which may iarise as a result of this change of contractor/subcor
permit. A permit cannot be cancelled if work has been performed.
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SIGNATURE OF OWNER (or o'wner/builder) GNA OF NEW GE
PRINT NAME PRINT NAME
State of Florida, County of St. Lu lie County State of Florida, County of St. I
The following instrument was acknowledged before me this The following instrument was a
day of , 20 II by day of
11 who is personally know to me
or who has produced as ID. or who has produced
Signature of Notary
*Only signature
Revised 07/21/14
Date Signature of Notary
luired for change of subcontractor
SLC License
3 SLC License
County, its officers,
all claims of action for
ctor or cancellation of
CONTRACTOR
County
>wledged before me this
by
is personally know to me
as ID.
Date
All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP-
Date: Permit
[LUCEE
rJ
r:
Building Permit Application
Planning and Developme7Services
Building and Code Regulation Commercial R Sidential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fai1: (772) 462-1578 �,� l ,/�Ho
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PERMIT APPLICATION
FOR: . ro
LOCATION2A
PROPOSEDwIMPaROUE
xENT
Address: `-t'UU �U
Property Tax ID #: 24
Site Plan Name:
Project Name: l
-mT Hwy -co
Lot No.
Block No.
�n� t 5U Lf-��i
1. 1 -Oc� )
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _Windows/Doors _ Pond
Electric _ Plu mbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 2— =� Sq. Ft. of First Floor:
Cost of Construction: $ j o � n`J Utilities: _Sewer _Septic Building Height:
OWNER/LSSEE�CONTRAC
S t 4y, -v++2S
TOtRv
. _.
Nam C
Company: v`2
Addr�ess2 G l t�t�
City: Y�� I `^ lii�
Zip Code:
Phone No
E-Mail
State or County Licens
+Y, ,re {� yt-'
y f F 4
() 1. <
Name Ui—� t
Addres q 0Q� �J 1`�'►(lY
City: P,e,ru,
Zip Code: � �
Phone No.
E-Mail:
Fill in fee simple Title Holder
from the Owner listed above)
1�1Gr�S
�S� �Jl-1UC
� State(-
Fax:
e�"t c
1 U State L
Fax:
)
on next page ( if different
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If value of construction is 2500'or more, a RECORDED Notice of Commencement is requi
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUMP;PLUM ENT�A► ��D N R�IJ' � x � ® '� �E A�Vlyr' 1S�N
F.O3R'M: l°O � �
��£
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: I' State:
Zip: Phone I '
I I
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
Not Applicable
II
I
OWNER/ CONTRACTOR At,�FIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installatlgon has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit h Ider to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants t at may restrict or prohibit such
structure. Please consult with yoiur Homeowners Association and review your deed for any re rictions 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 approvec plans, the Florida Building Codes and St. Lucie County Amenc ments.
The following building permit a )Iications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory',uses t another non-residential use
WARNING TO OWNER: Yot r failure to Record a Notice of Commencement may re ult in paying twice for
improvements to your',property. A Notice of Commencement must be rec rded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you in end to obtain financing, consult
%AA+k InnAor nr nn nttnrriav hafnra rnmmpnring wnrk nr rprnrrling vnur Notice of Commencement.
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Si ature of ner/ Lessee/ tractor as Agent for Owner
STATE OF FLORIDA C j
�-
COUNTY OF
'
Sworn o (or affirm d an subscribed before me of Physical Presence or
C4
nline Notarization
this T day of 20� by
makin state lent.
Name oj1dicat'
PersonOR
Produced Ide tification _L
Type of n Produced
G llQn�
(Signatur. No a Public- State
of Florida) Kenny Hsnxctvr
tPR
Commission
(Seal) a) Ri Notary Public
-State of Florida
r Comm# HH087667
yON,
I Expires 2/1/2025
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Kev 5/20/21