HomeMy WebLinkAboutChange of Contractor Planning&Dev pmentServices
tW Building&Code Regulations Division
2300 Virginia Ave.
Fort Pierce,FL 14982
(772)462-1553 Fax 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
X 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 now permit application must also be completed with new
contactor 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 AIC Change-out). A recorded copy must be submitted prior to
cominencing 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 I kew subcontractor must fill out a Sub-Contractor Agreement Form.There is.a$50.00 fee.for the Change of SA-
Co tractor.
I CANCELLATION OF PERMIT–The cancellation of a permit is acceptable only if no work has been done.
Cankellation 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. 4/21/16 Permit Number: 15010326
Site Address: 10331. SE Lennard Road, Port St . Lucie, FL 34952
S1 uth Florida Grading Corp
I State License.- SLC License
Original GC,subcontractor or owner/builder
B�b Elliot CBC 1259118
I- State License —SLC License
New W,subcontractor
Rea I on for Cancellation
Th�undersign'ed 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. A permit cannot be cancelled If work has been performed.
SIGNATURE OF OWNER(or owrieWbuilder) SIGNATURE GENERAL CONTRACTOR(o new GC,as applicable)
PAINT NAME 06W PRINTMA Rbb60L-J,
State offlorids,County of SL lfg;0Mi;aVftr-M04 M 10 State offlorida,County of SL Lucie County "01
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SIgnature OfNotary 1
Signature of Notary
Revised 04/15/16
All APPLICABLE INFO MAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
4/21/16 Permit Number; 1507-0326
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Building Permit Application APR ? 0 2016
Planning and Development Services
Bullding and Code Regulation Division
2300 Wginla Avenue,Fort Pierce Ft 34982 DEMO
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
-'
Address: 10331 SE Lennard Road, Port St . Lucie, FL 34952
L,Id10ndeu173118S1KI Tut PmldS8AOd ET(!et Ld11871 W-.Hoa Wod Nltd Fhf0110NMtl88(PH ffiQq&d WlYNDWWlld Le W SO,THN000080 EKG RW4811Fr Ta POB
Legal Description:
THN90WOO W778S Fr.THNa04t 54W17U7Fr,7t/N895749E2XOk Fr WLYRD aw tldLm dHO.TH S00 0300WAAHWW7794 FrTOPOB(1.IUC-47.237sF1OHWT.41).uec dedhM PLA3kRmciiddSLLLdeC4vq .
Property�Tax 1D#: 3.414-501-4702-0007 Lot No.
Site Plan Name: Block No.
Project Name: Family Dollar
Setbacks Front Back: Right Side: Left Side:
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ditional work to be Verformed un er is permit-c ec all that appy: .
^M chanical _Gas Tank Gas Piping _Shutters . Windows/Doors.
Electric _Plumbing Sprinklers —.Generator _Roof
Total Sq..Ft of Construction: Sq.Ft.of First Floor:
Cost of construction:$ . 0 . 00 Utillties: Sewer _Septic Building Height:
Name lHuttcn Team LLC Name: Bob Elliot
Address: 736 Cherry Street Company:Hutton Construction, Inc
City: Chattanooga- State:TN Address: 736 Cherry Street
Zip Code:3 7 4 0 2 Fax: 423-305-7879 City: Chattanooga State: TN
Phone No. 4 2 3-7 71-4 4 5 7 Zip Code: 3740 2 Fax:
E-Mall Tbeckner@button-.build Phone No 423-551-4202
Fill in fee simple Title Holder on next page(If different E-Mail BE 11 iot @button .build
from the Owner listed above) State or County License CBC 1259118
if value 6f construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESiG�ER/ENGINEER: _Not Applicable MORTGAGE COMPANY: X Not Applicable
Name Name:
Address: Address:
City: State: City: State:
Zip: I Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X,Not Applicable BONDING COMPANY: X Nat Applicable
Name: Name:
Address: Address:
City: City.
Zip: I Phone: Zip:. Phone:
I
OWNER f 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.Lucle County makes no representation that is granting a permit will authorize the permit holder to bolld the subject structure
which is I conflict with any applicable Homeowners 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 consid a ation 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'ornmencing work or recordingvour Notice of Commencement.
Slgnatur'I of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Halder
STATE OF TEO V)e*�� STATE OF'f�MIDA
COUNTYCIF
fM i IJSYI COUNTY OF I/I,V1A,� fl
The forgoInginstru ent was acknowledged before me The forgoing instru hent wap acknowledg cj before me
this a I I day of 20�p by this.�.-,L day of - (' 20 (Y by
(Name oil person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of � (Signa ure f Notary Public-State qF.RoNa
Personally Known ✓ OR Pro$ced lder on'• Personally Known^y OR Pi9dugd IdP*tio%
Type of Identification OF = Type of identification E TENNESSEE
Produced_ = : 'TENNESSEE _ Produced_ - ^TARY
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Commission No. Z ,y{SetguC .�,�'� Commission No. 'iy9A_'•.�(�Gd�1 �.J�.�`
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REVIEWS FRONT ZONING §U" AVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -I
-RECEIVED
DATE I
COMPLETED
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