HomeMy WebLinkAboutChange of Contractor ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t
Date: �a`11 S Permit Number:
L 1. ~�=.,- a RECEk D DEC 111015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 6008 Citrus Ave Fort Pierce 34982
Legal Description:
Property Tax ID#: �"1 1 1 - a a a a�- 4a0 -O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace receptacles with TR. & GFCI receptacles Minor electrical repairs.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
PJElectric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 2000 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameXiang guang feng Name: Robert Thompson
Address: Company: R. Thompson Electric, LLC
City: State:_ Address: 439 SE Cork Rd
Zip Code: Fax: City: Port St Lucie State:FL
Phone No.1-408-628-2502 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-342-2064
Fill in fee simple Title Holder on next page(if different E-Mail: sparks9634@aol.com
from the Owner listed above) State or County License: 23036
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 restrict or prohibit such
structure. Please consult with your Home Owners 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement,,`?
s
_Signature caner/Les gent ign ture of C acto
se Holder
S E OF FLORIDA STATE OF FLORIDA ,
COUNTYOF S�• -yG•\� COUNTYOF s+•
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this l day of D C 20 15 by this \N day of b-C. ,20\5 by
_C ha Y+n . S o r % e c -'sc -Cho un", I\
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida ) (Signature of Notaryblic-State of Florida)
G�VENc F�Oi�da ,,
eldica
,�i'� �i� Personally Known OR Produce Id � �nIEN
Personally Known OR Pro uce
Type of Identification Producgd� �'�La Puetesti° y Type of Identification Produced SEP• State o,r 2016
..........
, �e` c �ceE858161
Commission No. u9hNa�p° Commission No. �-C�rJ `�,_My �Ssion#Ea,No�a�y pssQ•
0 _ - Coen hNaGoQ
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Ill 11 ll � •IIII III\• '
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
PFrEIVED, DEC 112015
-- --------------- Planning&Development Services
Building& Code Regulations Division
but,
' CO
UN2300 Virginia Ave.TY
Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or su con factor or cancellation o erinit
Change of Contractor is to be completed 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,
signature, and transfer fee. A new Notice of commencement must be Med in the new contractor's
name for job value's greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Any cancellation of permit must be executed by the owner or qualifier of record.
Date: J. 11145Permit Number: I 5�O 9—v016`
Site Address: 0 0 0(yg V5 Vu
State License SLC License
Original General Contractor(or Subcontractor)
-State License SLC License
New General Coiltractor(or Subcontractor)
Reason for Change 0
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 contractor/subcontractor or cancellation of
permit.
SIGNATPRE OF OWNER (or owner/buRder) SfdNATURE 0yNEVFG1&ffWcrC0NTRACTOR
PRINT NAME PRINTNANM
State of Florida,County of St.Lucie County State of Florida,County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
Aay of �20�by _q_day of_b�C .20%5.by&10'0R_J_*
who is personally know to me Q 5 T's who is personally know to me
or who has produced as ID. tior whoh'as prod ed as H).
Signature of Notary Date Signature of NotaryDat WON S Fi01tda
pljbkic. 0 A6,2p18
tAotaN �J'Ofes De
*Only signature required for change of subcontractor 00