HomeMy WebLinkAboutContractor Chg 2011-0006COUNTY
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING, DIVISION
2340 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PE RNvr
PLEASE SLl FCT ONT OF J-HE FQLt OWlN(J:
��CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized by the property o%%ner.
and the ncN% contractor of record for the current permit, A nee% permit application must also be completed «ith nc%k
contractor informalion and signature:. A neck Notice of Commencement must be filed in the new contractor's name
for job values greater than S2.500 (S7,500 if A/C Change -out), A recorded copy must be submitted prior to
commencing any work. There is a S50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Agreement Form. There is a S50.00 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: �/ ►I c, Permit Number:
Site Address:
5.xt51�,1�e t�,orssi-r�e�•o� t 0e.ve^me-.-i State License 27a 5LC License
lo
Original GC, subcontractor or owner''builder
L C- State License �- � 1 (`' 3 SLC License ---
New GC, subcontractor
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, whi may arise as a result of this change of
contractorsu ontractor or cancellation of permit. A permit cannot be can lied ' work h n performed.
S1C,-:ATI Rf {- 'OWNER (o ncubuil Cr -,16NAI U L GE:tiLRAL (TR fC)R (or neu GC, as applicable►
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PRtV"t NAME , �G
`AM vec
uia . nn��� � _
state
of t londa. County of St Lucie County
the following tnstrumerx wffi acknowledged before me this
_dai of 1—, 20
ufio is persomilly known to me
ID
signaliirt f N
State of Florida, Count) of St t.u(ie Count)
the o1lo%ing in+trument Has acknowledged before me this
_g�,.._.dai of O_a /.1.U,?;? by
I : e%(KC' ( penonali) known to
nw or oho has pnxi as ID
♦t>�e * *ar) V Date
Y 04e Notary Putlkt Stets o1 FiOhNi
'F Alexander M%jazi
itlM/t/WaM�v� .on NH OW40
Notary Pubk State ofAlexander iiBjA>!l
R
W C-om nmiiion 141.1083146
Expires 01W/2025
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �'0 Permit Number:
L,��L
6
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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION p, �
Address --UCoe
�7
Property Tax I D #: 5 L-)) L J - Sol _ lg� ' Q / C) - Lot No. 3
Site Plan Name: Block No. 3
Project Name: P1'���'SICG\ r—C1,;�i� Gr�r�e--
_
' 7 AILE_D DESCRIPTION OF WORK
.. - —
IVN,Cr_ ron 100_C
New Electrical Meter Second Electrical Meter (Affidavit required)
4 i_�ONSTRUCTION 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: 9 Lid Sq. Ft. of First Floor:
^
Cost of Construction: $ Utilities: —Sewer — Septic Building Height:
"OWNER/LESSEE: CONTRACTOR:
Name (n Qr�G 1- - c c Ck r Name: C1Nc"e_k 6czy
Address: '�� 1Z4 S . US 140 Y � Company: J- Iof e 0 L C
City: B2!. J 1—VL+e State: FL Address: 1 q4Pi_.) 4,e
Zip Code: 3J-1 c1 50 Fax: City: _(,Je � State:
Phone No. 77� - y�/6 - 9C) E- Zip Code: 1 Fax: _
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail zn., - e C /e-v P,h arY+e -�•�
from the Owner listed above) State or County License C13C % 26, 990
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.
i
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Zip: Phon
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name: _
Address:
City:
Zip:
Phone:
_ Not Applicable
ate:
Not Applicable
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 prohibit such
structure. Please consult with 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
'th I d r an a orne before commencingwork or recordin our Notice of Commencement.
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wen e
i
Signat e f ontractor - or er Builder as applicable
STATE OF FLORIDA
COUNTY OF '3-,,, - l_ L
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this a a day of 09 20D by
Name of person making statement.
Personally Known OR Produbed Identification
IX —
Type of Identification Produced `�)
(Signature of Notary Public- State of Florida)
Commission No. (0 3 (Seal) -"a No" Sweort�
Alexander Fbj�s!
MY Comm r 49 W 089143
ExOm 0 120/IM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21
Rev 10/12/21