HomeMy WebLinkAboutCHANGE OF CONTRACTORPLAN
BUILI
2300 N
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FORT
'� P et�ia�`°,nI 772) 4
PLEASE SELECT ONE OF THE FOLLOWING:
X CHANGE OF CONTRACTOR — C
and the new contractor of record for the currec
contractor information and signature. A new ]
for job values greater than $2,500 ($7,500
commencing any work. There is a $50.00 fee
CHANGE OF SUBCONTRACTOR
The new subcontractor must fill out a Subconi
Contractor.
CANCELLATION OF PERNIIT — T
Cancellation of permit is to be signed and no
cancellation of the permit.
Date: 7/29/19
Site Address: 2320 Oak Dr, Fort Pierce, FL 34949
Group One Construction & Development
Original GC, subcontractor or owner/builder
Site & Studio, Inc
New GC, subcontractor
Reason for Cancellation
� U 7- X)
i1G & DEVELOPM164'' SERVICES
G & ZONING DIVISION
GINIA AVE RECEMD
MCE, FL 34982 AUG 0 6 2019
1553 FAX 462-1578
ST. Lucie County, Permitting
mge of Contractor is to be signed and notarized by the property owner,
permit. A new permit application must also be completed with new
)lice of Commencement must be filed in the new contractor's name
'A/C Change -out). A recorded copy must be submitted prior to
it the Change of Contractor.
Subcontractor changes are to be completed by the general contractor.
ctor Agreement Form. There is a $50.00 fee for the Change of Sub -
cancellation of a permit is acceptable only if no work has been done.
ized by both the .owner and qualifier of record. There is no fee for
Permit Number: 1806-0390
License CBC1250688 SLC License
License CRC1331263 SLC License 31z 8 3
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, which may arise as a result of this change of
�gmtteact6r su co ctor or cellation of permit A permit cannot be cancelled if work has been performed.
SIGNA OF OWNE�(orown�erlbuild�,,)
PRINT NAME/Z��Zf � y /L •` (, ��
q� ir7�1 rr1�RJ-�'}
State of�wl da, County of St-i acie County
The following iAstrurr}ent was acknowledged before me this
day of %-•�, l -1—, 20 ��by
who is personally known tome
n,!as ID.
19
Signature of Notary ►• X '4V
2 L,tUOF NEW JEMEX �
My C rdjJwion.E se 04 24, Mil
Revised 04/15/16
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINTNAME
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to
me or who has produced as ID.
7/29/19
Signature of Notary Date
All APPLICABLE INFO MUST BE COMPLETED FOP
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address: 1Z(
Property Tax ID #:
Site Plan Name: _
Project Name: -
►PPLICATION TO BE ACCEPTED
Permit Number:
gilding Permit Applicatiop AUG 0 6 2019
tT. Lucie County, Permitting
Commercial Residential Y—
Lot No._45�_
Block No. 2.3
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ as Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator:., Roof. : ;:Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer iKeptic Building Height:
O NE R, /HVSs�E...
C� TRACTOR.
Name + :C_.' 0
Name: n
Address: l
Company:.s.y�. - "" '
City: 9 State: A0
Zip Code: Fax: I
Phone No. Q 09 3-3 At — poz
Address:
City: YcCZ_�
Zip Code: �40 ._ Fax; dd_ .•CC_nn:,,��_
Phone No�%�"30%.`
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
i
1
E-Mail -P/`G.n K . L: e-6ler PO teaccow
State or County License CAC_ M 1�1 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED NoticIe of Commencement is required.
P A T11 C}
DESIGNER ENGINEER:. _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:.
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrictor prohibit such
structure. Please consult with your Home Owners Association and'review your deed for any restrictions which mayapply.
In consideration of the granting of this requested permit," I do hereby"agree, that I will, -in all respects, perfo.rm'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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF Y.OU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF' COMMENCEMENT.
Signature of Owner/ Lessee/Contractor as'Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr ment was acknowledge before me
The forgoing instrument was acknowledged before me
this V, day of 20 by
this day of 20_ by
JI�LC-
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known • OR Produced Identification
Type of Identifi ion
Type of Identification
Produced L
Produced
/NIEL.
(Sig natu _
(Signature of Notary Pd.blic-State of Florida } '
KA;REN S. EN
e'c
Commissio
�State;,of Florida NotryPu84c
3f
Commission No. (Seal)
. .- n # G
.
My Commission Expires
'11",� ,% June 12 2022 -
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Rev. 2/7/ 19