HomeMy WebLinkAboutChange of Contractor 6{
PLANNING&DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION
2300 VIRG NLA►AVE
FORT PIERCE,FL 34982
FEB /8 2017
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE F LLOWING:
CIIANGrE 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 infonIiation 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 roust 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.
CANCELLA'T'ION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of pemit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: —z— %
_ Permit Number: c:.)
Site Address: '2—S* 1 7.7
State License SLC License 3
Original
� GC,subcontractor or owner/builder
State License SLC License 11/.72 '
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from aII
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a resin fthis change of
contractor/subcontractor or cancellation of permit.A pertttit cannot be celled if wok has been ormed.
SIGNATURE OF OWNER(or o er/buildtn') / SIGNATURE GENERAL CONTRACT (n°rne/w�GC as applicable)
PRINT NAME • o c,9) PRNTXAME �+JIQ
Slate of t lorida,County of St Lucie County State of Florida,County of St Lucie Gmmty
The following instrument was acknowledged before me this Th following is tiu e t was ack&Medged betare me this
d8 20 ,by $ Gdayof-� 20f-1"Y
j who is pe stmally known to me� ___ ,,, who is pLRwonaUy(mown to
r,o—
mt or who ha$px cedKerry James Ellis
f Notary NO signature of Alotary � Qr °�'s Notary Public
_ State of Florida
Revised 04/i5/1$ �SpRY PVe�/n JOy.%1141E HILLS,SR.
y
M Commission
#FF 211362 Ex fres 8113/2018
N ' Ei;PIHES:July 18,2019 p
.,y'F-1 FL ° Bonded Thru Budget Notary Services Commission No. FF 150837