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HomeMy WebLinkAboutCHANGE OF CONTRACTOR PLANNING & DEVELOPMENT SERVICES fr BUILDING & ZONING DIVISION ' 4 2300 VIRGINIA AVE RECEIVED FORT PIERCE, FL 34982 MAR 2 2022 (772) 462-1553 FAX 462-1578 St,Lucie County Permitting CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: 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 b both the owner and qualifier of record. There is no fee for p � Y q cancellation of the permit. Date: '7 '2Es'� — Permit Number: L �� Site Address: 73 77 Cm t-C-ra'l GfL /`- 7 A116 Ft potj/ J a J in f 576)y S State License SLC License Original GC, subcontractor or owner/builder W1 State LicenseC6C IS31 O5 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 d ages arising from any and all claims of action for any reason,which may arise as a result of this change of co tractor/s c%ntra,ptor or cancellation ermit.A permit cannot be cancelled if work ha een performed. G TURE OF WNER(or owneribuilder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) INT NAME PRINT NAME_ 6:'&) Pal., evl Pam State of Florida,County of SLlu� State of Florida,C nThll—owing instrument/was acknowledged before me this T1}eSfQllowing instrum t was aclmowledged b fo a me this C ��' day of �i''6'l 20�by (12 ! day of ,20D Z;by r G,a.wl rw is[V 0 who is personally known to me C)4,+ 4 k\ who is personally known to z or who p oduced t}� as ID me or s produce .W (L s ID. 2� 2� 2c 2 Signature of Notary Date Signature of Notary Date KEE] TEVEN SIEGEL µ ;o��{v'pgll% STEVEN SIEGELRevised 04/15/16 '?: 1':^ Notary Public State of Floridablic-State of Florida �, o Commission p GG 261994ission N GG 261994 ?!F°r t��?. Y M Comm.Expires Sep 25,2022.Expires Sep 25,2022 -3 t _ �� r - �� q - , -z . . . . . , � . . .1� �}4 _ . _ �:•. _�.. � 5'- .. ICY All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `.lez,. l 2,2 L Permit Number: 2 U-3`CJ--S RECEIVED Ljl ll MAR 2 8 2022 Building Permit Application St.Lucie County Planning and Development Services Permitting 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: Pi�C}P©SED IMQUEMENT I.00ATRt ,.�._. �r } ;?�,` ..,: F N = . i. Address: �73 9:2 Cn- GrN- FL a)S 1 Property Tax ID#: I33��D Z O 0 q q c>66 Lot No. Z Z Site Plan Name: SADl w-c ioL) /33 !ZS' © Z C / Y Block No. Project Name: DEfiA( fD DESTRTIO�N WCtRIC• �£, ,a Y t t ,�', 5�7 r _ . �. ��, o vep New Electrical Meter Second Electrical Meter (Affidavit required) VF, ✓ '` r t 5' ,},r. 3 i F b '` \k$9 p - € 't in` a x3 L I-'` q`, COI�TRUCTI �t�FORI {ATION „ 's x _ 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: $ 0,0 0.0 Utilities: —Sewer _Septic Building Height: Name !o �S G �iSI �C Name: �IeN ® Sa Address: 2 6g'o 416m 11�I 't Company: Fl\erce City: 1tif{lhl�� AZIL State:L Address: 1801 '-)2k4OrS 1-L Zip Code: 12.7 9 2. Fax: City: A l�ar� State:��-- Phone No. "1 2 V �`�%�' E- Zip Code: 33308 Fax: Mail: o C/{frl C�If,/v/c%�� �ro� Phone No Z9rD'23('p-,I,;r3 Fill in fee simple Title Holder on next p e (if different E-Mail fit?'`iJ ke-4 t- from the Owner listed above) 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. ! �ll.��L�IUIEfU��LkG4NSTRk�C�I"iDl� LIL= �t�11U�NF�RMATIQI��•,K�� � ��;4;� � - ��. ,_,� ',��-5� , � � �_�, _ DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: ! Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: 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 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 with lender or an a4torney before commencing work or recording our Notice of Commencement. Signature of Contractor-or-Owner Builder as applicable STATE OF FLORID I j� COUNTY OF �alW� Q.��CJ�� Swor t r affirmed ands bscribed before me of Physical Presence or Online Notarization thi dayof � V\ 20�by Name of person making statement. Personally Known OR Produced 'flentification Type of Identification Produced 00vi Vt&-( eoSJ, (Signature tar Publi ate o lorida) ............., STEVEN SIEGEL Commission No. (Seal) I'. r�Ga' Notary Public State of Florida =� H �= commission N GG 261994 My Comm.Expires Sep 25,2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev10/12/21