HomeMy WebLinkAboutChange of Contractor * sry PLANNING & DEVELOPMENT SERVI �,_CEIED
�,
' BUILDING & ZONING DIVISION '
2300 VIRGINIA AVE
s F
FORT PIERCE, FL 34982 JAN 17 2011
(772) 462-1553 FAX 462-1578 PERMITTING
St. Lucie County, FL
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMIT
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
$ a of Contractor.a is 50.00 fee for the Chan
commencing any work.There g
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.
I `
Date: f/I2—/1 Z Permit Number: �7(5/ '62 Q y--�
Site Address:l0 : � 1 V�
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CCc ft�-
A&Ao 400f/-,/ za e— State License SLC License ZZQ ?0
Original GC,subcontractor or oo nerlbuilder
S h esti POr/EIV Tl L' State License CeCC/32 -9/e/?LC License
New GC,subcontractor \
Reason for Cancellation 9C` CL!&,_, c/ t Cc _ J
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,it§officers,agents and employees from all
costs,fees or damages arising from any and all claims of action forp y re on,which may arise as is change of
contractor/subcontractor or cancellation of permit.A permit can t be ca elle77k as rfor
SIGNATURE OF OWN/�ER/(or owner/b lderr) SIGN GENEERRA/L CONTRA TOR(or new GC,as applicable)
PRINT NAME ( 1 C, C b i yu PRINT NAME /l�f"I Ul D
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this 1hoollowing instrument was ac o led ed before
, day oft N 20 jq,by day of 20 by �T
fJ who is personally known to me k who is personally known to
or who asp uced D- - as ID. me or who h oduc d - as ID.
�-- 7
Signature of Notary Date Signature of Notary Date
WIMI KAREN S. NIELSEN ;'"�"a KAREN S. NIELSEN
\ I��/ ,\\ pY v y'�j�
;``°�' BB Z. `�= Commission#FF 115637
Revised 04/15/16 =�/ ry„ *= Commission # FF 115637 _� ,_
My Commission Expires My Commission Expires
June 12, 2018 June 12, 2018
'.rn.„\\\ ,,,„\\
,ten e� PiICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1701-
RECEIVED
Date: Permit Number:
JAN � 7 2017
_ Building Permit Application
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
c r100
-ix�a a PIN
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Address:
Legal Description:
Property Tax ID#: /`7JZ ®'I 0015- 600 -- -7 Lot No. 12-
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator of
Total Sq. Ft of Construction: �/300 Sq. Ft. of First Floor:
Cost of Construction:$ �5; Z 00 Utilities: —Sewer _Septic Building Height:
7">:s -...�.'',�-r[�..` _ y - -.' EL''#"`�x "s "�"`" .3„ r 5r•r -� n.�.k� _,tii,- tw.. K.:x` L". -SI i 'rt°+'�4 ,a.�, s F
Timv'�F. 5 -,
;ter.:,_ i'`=f..:._ Y3'�. »--.
Name l �f'�� 1�/I'!.. Name: DAuLb IJJ18Akit)
Address: 01 Vc Company:BAZ FA lc�C�C��/� ,;�Z'2- '
City Axype c- . State:6L- Address:
Zip Code:_?yR VFax: Ci ty:�drom hi%c,- v Stater
Phone NoW.-�P"z6 0-6 Zip Code:33 0'6 Fax:
E-Mail: Phone No511",20 6Y�11
Fill in fee simple Title Holder on.next page (if different E-Mail:c/iCt d v Agolae , C
from the Owner listed above) State or County License: Ca--IJ Z;V S15
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�` -�s3"s(.�`tx'',= a- -�v�$�r q h :rte .G ,.•d ��"*� .tF � y':,- -�:.t'. - � ,� � 3 � J 5 �, ��.r.F "i
�,r�- ��.. -s. ��� "�:�-�'.��� Y �� v" r r >�> '�R..�:}�S � � •'s. zt�`^" #,�"� �?���y�4'�4�'a�,� > v*r ��� 'EtP�
��. ._�• ,c-p�� ,� ���� � .��'"''-���„ ,. �.=r ,��-ww..�'a=te-.'�1� ate..„�"�� � �_�- ..�� '�f-`��._��Y�2"moi`F.- �,.,,.:�'�.
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 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
comp:w-ocing work or reco di our Notice of CommencemeQt.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA C, /
COUNTY OF �l/�'��� COUNTY OF G llCIC-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledg d before me
this/ Aday of BTW flf 20Z2 by this�ay of T l/1,05� 20�7 by
(Nam of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification I
_ Ty_ .e of Identification Produced Type of Identification Produced
Commission No. ,,.;:�a' REN S. NIELSE ,,,,,,,,
qSe J�` Co mission No. KAR ReSt)NIELSEN
ommission N FF 115637 rho
'• *= ;�i� g Commission S FF 115637
- = My Commission Expir s =. +_
'.,q�E b•a - My Commission Expires
une
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA G O 12. 2018E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-R—ev-7. 7/2014
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4267644 OR BOOK 3953 PAGE 1356, Recorded 01/17/2017 11 :55:04 AM
Irl"atCEIVED
NOTICE OF COMMENCEMENT JAN 1 7 2017
PERMITTING
Permit No. Tax Folio No. 1432-801-0015-000-7 5t. Lucie County, FL
State of Florida County of St.Lucie
The undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following Information Is provided in this Notice of Commencement. Wr
U
Legal Description of Property:(and street address if available); i
Sheraton Plaza-Unit One-Lot 12(or 3327-93;3328-2318;3328-2319) 104 Bedford Drive Fort Pierce,Florida 34940 y
Y v
General description of improvement- Re-roof
P P za
w
Owner information or lessee Information if the Lessee contracted for the improvement: Q,
Name Aliecie Dixon cn U-
Address 106 Bedford Drive Fort Pierce,Florida 34946 cn O s
Interestin property: owner a U CV
Name and address of fee simple titleholder(if different from Owner listed above): Q x�
}W U�
Contractor's name: Barton Roofing, Inc. a=_
Contractor Address: 737HummngbirdWay#10North Pam BeaMFloWa3mae Phone Number:Sal-soM-o4m ix � �Q
OOV0 o�
Surety(if applicable,a copy of the payment bond is attached):Amount of bond:$ U ful
w_O O
Name and address: Phone number: O U 1--
Q 0
LU=-- i;
Lender Name: Phone Number: j
Lender's address: W to f-F- cc fl
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.23(1)(a)7.,Florida Statutes:
Name: Phone Number:
Address:
In addition to himself or herself,Owner designates of to receive a copy of the
Lienor's Notice as provided In Section 713.13(1)(b),Florida Statutes.
Phone number of person or entity designated by owner:
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor,but will be 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER:ANY PAYMENTS MADE BY THEOWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN 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 YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENONG WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my nowledge and belief.
(Signature of Owner or Lessee,or Ow is or Lessee's Authorized Officer/Director/Partner/Manager
Owner
(Signatory's Title/office)
The foregoing instrument was acknowledged before me this 11 th day 012DUar , 20,17,
By Allecia Dixon as Owner for
Name of Pers Type of authority(e.g.officer,trustee) Party on behalf of who Instrument was executled
Personally known To� r produced(denttfication_.
(Signature of Notary Public-State of Florida)
(Print,Type,or Stamp Commissioned Name of Notary Publ ,. F�$h, SDLO.WNIVE!of Iden4ification produced
{f. .-E MY COVd�4MI0N d FF 9123V I
f ,ra! EXPIRES:Novemb9r is,209
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Banded ThruWay PYt:fGUndanvFJM1 t�
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