HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION ��pr�
MOM 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JUS! 2 7 2096
(772) 462-1553 FAX 462-1578 PERMITTING
St. Lucie County, FL
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 by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: (9- 2-24 Permit Number: 9 LQ n 5-
Site Address: 03 gio o cv- Lr- �?
Slel PK1 D f R n Q6 State License SLC License 2 l
Original GC,subcontractor or owner/builder /i
b p"Z�k (2O n6i1 1AC'�'l D t\ LLC State License CCC Ory 66 to SLC License
New GC, subcontractor
Reason for Cancellation 'Rx-AA V eo p'n S uCJec`0 c' FCC �
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.A permit cannot b 7
celled.if work has been performed.
6RX-ye)
SIGNATURE OF OWNER(or owner/builder) SIGNAM —DA
ENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAMEt�i\C. 0( PRINTy)�e L `Dn__>Ac V_
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me_this Tj e,.fpllo wing ins ment was acknowledgedbefore mg this
day ofd t 9�F 20� by— C � oda of nc
who is personally known to me �0 XQ C who is personally known to
or who has pro ed �U �' as ID. me or w1ohas
�prpduced ID. A
- to 9 ��
Signature of Notary Date Signature of Not Date �a—r a,v
tj
_ KAREN S. NIELSEN
;•Wr= Commission N FF 715637 Lori A.DeS"
Revised 04/15/16
of My Commission Expires NOTARY PUBLIC
OF FtO,� June 12, 2018
------------------
STATE OF FLORIDA
VIEVIres
Comm#FF064453
10/20/2017
All APPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: 10�2�"" lam— �?`�C .l:�-d`t'; permit Number:
T y _
f z JUS ? 7 �1~ �$$
,.
I
1 PERMITT'ii1G
,. 9
a St ie C my t LiJUm 2
BuilaingWe M' t.Application PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Fe t'
RROPOSED INpROVEMENT LOCATIpN.
p n 2 , .
Address: 30? 16 o t�ci Dl�[ ye U S1- F[, .=7 q,6'2-
Legal
7J�Z
Legal Description:
Property Tax ID#: 6D - d - �. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAII:ED QESCRIP;TION OF WORK
�.
�2/) S oe l xL 6,44 4 Cl )zber
CON
5TRUCTION INFORIVATION
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _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:$ 2- �16C'6- cm Utilities: _Sewer _Septic Building Height:
01NNb, LESSEE CONTRACTOR
,ter., _
Name �51 C �'': IYO ad Name: . l-e' Z`4C
'.r
Address: .300 X✓0 1'��E� ��' Company: / ozCT.ck �> �cd7U� LLC
City: )sL State: 4"Q- Address: 17VI Y1 V>1 �-
Zip Code: 3y I<Z Fax: City: ,SSL State: �L
Phone No. 3 59- S-7,YS Zip Code: Fax:
E-Mail: Phone No. S'3� �' 2 05
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: C o 2 Ll (.6 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFQRMATIQN
DESIGNER/ENGIN ,�o �..-F.• �. � .�
EER: _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 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
commen,qng work or recording our Notice of Commencement.
SignatureO Agent/Lessee Signature on ractor/Lic er
STATE F F RIDA STATE F FL IDA .
COUNTY 1 � Q COUNT S LU CJ
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this 2k day of CSU V\ 20-L6 by
croL- iL Lu(I isjatlarwO Vnp UA:�s k�lIa y-y-0 <TV,
(Name of pers acknowled i (Name of perJn acknowled i g-).— _1
(Signature of No - tate of Florida ) (Signature of - a e of Florida)
Personally Known R Pci�OE�t$} qiQ� Personally Know'-Q,,,,.- 8t [l�d tication
Type of Identificatio Type of Identif' pkv Uplj
STATE OF FLORIDA STATE OF FLORIDA
Commission No. mm#FF( 6 Commission F149266 (Seal)
Expires 8/10/2018 ��° Expires 8/10!2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.