HomeMy WebLinkAboutChange of Contractor M if
Planning&Development ServicesRECEIVED
7 " Building&Cade Regulations Division
p 2300 Virginia Ave. MAR 201 '
o , Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578 PEF;"&CMN, G
St. Lucie Gounty,FL
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: t t Permit Number:
' -� l (
Site Ad ss: �'— -
CA
to License, �' t 'TLC License..
,,r��Original General ntrra'c�tor(or Subcontractor) � C
t z V) a\ka6 EL}• S{, i C,0 612-S State License CB C!�2- SLC License
New General Contractor(or Subcontractor)
Reason for Change iab., t c.."3::-
The undersigned does hereby agree to indemnify and hold harmless St.Lucie Tounty,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/sipcontractor or cancellation of
't. Ape cannot be cancelled if work has been perfor d.
ATtTRE OF O (or owner/build&D 6WAkRIE OF NEWG CONTRACTOR
PRINT NAME � / PRINT NAME?()tJ r(i�
MA+''hvt
State of Florida,County of St.Lucie County State of Florida,County of St's
ollowing instrument was acknowledged before me this Mayf
wing instrum•en�t tw,as acknowledged before me tins
day of 20�-by�j� M t�i.,,20_nbyLOCJ�"�A
K-,4�who is personally know to me 4w�who is personally know to me
or who ha ueed - �as ID. or s�p-�dfd a
�� �
Signature o Notary Date 3 1 Signature of Notary Date
*Only signature required for change of subcontractor o PE~~P6�CUp
Revised 07/21/14 NOWPublie.-State of Florida :
F"N gCommisslon N FF 9957t6
�., RiANA ALL! My�o .Expiias May 24.202u
�°+= Notary Public State of Florida '''yf1����,t„IIBondedthroupth National Notary Assn.
=M Comm.Expires Jun 23,2017 Y¢� Commission#FF 030?45,, 1
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Mar 0917,07:31 p RLH Builders 7722213783 p.1
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All APPLICA LE INJO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1-701 0:r_f 2-
Date: Permit Number:
S'
s y
Budding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
,1, f
Address: �Ili-tt>t C.L4l 13L�iL.i!►�� IVB
Legal Description:-41- N10• I tArT- We-
i f /�
Property Tax ID#: �?(.r"' Yti !7( ( bE�t� ^l5 Lot No.' l
4
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
0,WP*,% 1 P +CL:-d rG
itiona wor to a per Orme under this permit-check all that apply:
,Mechanical —Gas Tank „Gas Piping u Shutters Windows/Doors
_Electric ^Plumbing ^Sprinklers i Generator Roof Pitch
Total Sq.Ft of Construction: hydi7 Sq. Ft.of First Floor:
Cost of Construction:$ 60 Utilities: _Sewer Septic Building Height:
s,
Name Name: b�
Address: Company JLi4 Gt t at9an��
City: State: Address:417 I Se 4U -'�'
Zip Code: Fax: City: _ 1L%kla-rl--T- State: L
Phone No. Zip Code: 3)q![!7 -? _ Fax.
E-Mail: Phone No Z! $-^- V ce'-'-
fill in fee simple Title Holder on next page(if different E-Mail g_L44 13t t t taa vrt (f
from the Owner listed above) State or County License ._
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.