HomeMy WebLinkAboutChange of Contractor _ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
AVE
2300 VIRGINIA a I
�---- - — FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
I
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: 1� 1-7 Permit Number: &0 -1001 N
Site Address: _' vQAJ Fnl(,S
Uo_ State License Cns q SLC License
Original GC, subco tractor or owner/builder
lco (St6nmao State License 10 SLC License
New GC,subcontractor
�,�rte, � !!�y� �,,/i�Q
Reason for Cancellation Eric, �'ey L�JI.) � no Iamoc�� ffI I 1I Io &i
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 cann be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIG RE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINT NAME_ til ICI1 `S (IYY�G Yl
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 acknowledge efore me this
day of 20by day of�Q_20 by �S�f7man
who is personally known to me who is personally known_to
or who has produced as ID. m or o has oduce4 as ID.
Signature of Notary Date Signature o otary D;t '+„''•, `DATTIE JO NETTLES
MY COMMISSION#PF952984
Revised 04/15/16 ”,?P EXPIRES January 21,2020 i
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ALL.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/11/2017 Permit Number: SLC-1601-0289
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3024 EAGLES NEST WAY
Legal Description: EAGLE'S RETREAT AT SAVANNA CLUB PHASE 2 (PB 43-21),BLK 65 LOT 7(OR 3690-1394)
Property Tax ID#: 3424-702-0216-000-3 Lot No.7
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: "
WH CHANGE OUT 30GAL. PLEASE ISSUE NEW PERMIT TO SUPERCEED PERMIT NUMBER
SLC-1601-0289 DUE TO NEW QUALIFIER.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tispermit—c eck all appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 71 Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 400 Utilities:Sewer 0Septic Building Height:
-OWNERAESSEE: CONTRACTOR:
Name JANET&DANIEL F COYLE Name: ALLEN STEINMAN
Address:3024 EAGLES NEST WAY Company: SERVICE AMERICA
City: PORT ST LUCIE State:FL Address: 2755 NW 63RD CT
Zip Code: 34952 Fax: City: FT. LAUDERDALE State:FL
Phone No. Zip Code: 33309 Fax: 954-977-3591
E-Mail: Phone No. 954-979-1100X5673
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.
>SUf'P;LEMENTAL 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 thepermit 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
Si na r of Owner/Lessee/Contractor as Agent for Owner SignatuCVbf Contractor/License Holder
STATE OF FLO A STATE OF FLORIDA
COUNTY OF Li binlord COUNTY OF C'QVVrIrd
The fot going instru ent was acknowledged before me The for oing instru,r��,ent was acknowledged before me
this I day of n 20 1�by this day of lJu I V t�1 20 _a by
-Allen 'd6nrnan &,03 L<teihm rn
(Name of person acknowledging) (Name of person acknowledging)
J� n&V_62I) I lukdj��
(Signature of 1\16tary Public-State of Florida) ( ignature o otary Public-State of Florida)
Personal) Known Y.. t�I ET n'!l!
Personally &?��Pr�"d9�e dc�r�ificati Personally Known OR
Type of Identificati P�bd tcecl MY COMMISSION#Fr — Type of Identificatio Pry}, PATTIE JO NETTLES
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Commission No. rr � ` `°," , ^ _S ommission No. xpl ry
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Revised 07/15/2014 (4071398-0:53 FIw AaNclarv9ewux ca" (4071398-0 53 FlaidaNclarvSery ce an,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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