HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
- -- - FORT PIERCE, FL 34982
(772).462-1553 FAX 462-15178
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE ELECT 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:
I Permit Number:
Site Address:' sbO2- iG 1,JC4 ��✓c�C
C ►�+ 'r l' State License U05P 5q kLC License
Original GC,subcontractor/or owner/builder .�
411�n �c omrn State License C�-C1Q2(,19SLC License
New GC,subcontractor
Reason for Cancellation Dcl uct0 A e r , IND )cT� Cr crr !O 6G
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 ca celled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNA GENERAL CONTRACTOR(oi new GC,as applicable)
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PRINT NAME PRINT NAME D e Ir
fn �O`/'11�
State of Florida,County of St.Lucie County State of Florida,County of-St.Lucie County
The following instrument was acknowledged before me this Thq following instent1was acknowledge before a this
day of 20_,by _ day of T Pl /1Gf
who is personally known to me who is,personally known to
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or who has produced as ID. me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
Revised 04/15/16tz� c Amanda Montes
NotaryPublic-StateofFlorida
Commission#GG 33871
Expires 9/27/2020
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 ,,
Date: Permit Number: n9k - 33
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
PERMIT APPLICATION FOR: To//// Select from dropbox^, click arrow rat the end of line
:lll� O14'OS � � �.bVEMEN0� � �l�'44� Mlle G _ _� rY } i�
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Address: 8024 KIAWAH TERRACE
Legal Description: POD 25 AT THE RESERVE LOT 16
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Property Tax ID#: 3327-705-0017-000-9 Lot No.
Site Plan Name: JOHNSON, MARCUS&CONSTANCE Block No.
Project Name: SERVICE AMERICA
Setbacks Front Back: Right Side: Left Sidi
th� IT
�Tr "`s,' !I ., mY' o n a� SLB - l IN— ��I �s x B '� b, . tit', :
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WH CHANGE OUT 50 GAL ELE
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C4NSTRI-C1'fNIF.O'
Mona work toa er orme under t Is permit—check a appy:
HVAC 11 Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric RI Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.;Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ 550 Utilities:cn Sewer Septic Building Height:
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NameJOHNSON,MARCUS&CONSTANCE Name: ALLEN STEINMAN
Address:8024 KIAWAH TER Company: SERVICE AMERICA
City: SAINT LUCIE COUNTY State:FL Address: 2755 NWI63 CT
Zip Code: 34986 Fax: City: FT LAUDERDALE ± State:FL
Phone No.772-467-0986 Zip Code: 33309 i Faz: 954-977-3591
E-Mail: Phone No. 954-979-1100
Fill in fee simple Title Holder on next page(if different E-Mail: EPERMITSGROUP@SERVICEAMERICA.COM
from the Owner listed above) State or County License: CFC057026
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CO'NSTRUCTION.LIEN°LAW INFQRMATION.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State:
Zip: Phone: Zip: I Phone:
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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,pefform 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 concurrenIcy 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.
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Signature of ner/Lessee/Contractor as Agent for Owner Signature of C cior/License Holder
"STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for ling instrument was acknowledged efore me The fQ oing instrument was acknowledged before me
this day of �G'1 20 l�y this I f day of�;n 20 ��i^by
(Name of pe orrazknoWled _ (Name of person ackhowledging)
(Signature c:S Florida (Signatur otary Publi.-State of Florida�-
,�p,RY Ppb Aman a lvlQ t S
Personally In. e c t9@?SGA'u%at�or?Spl irf1S ion Personal] o aims?rq:1 Meds nti is tion
Type of Id t od �A. Type of I ti iol'�41blic c
s,F far , al 33 01 nca
Expires 9/27/2j}20 ) FLo� Ex Commission#GG
Commissi l eaI Commis ' Aires 9!27/2020
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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