HomeMy WebLinkAboutMisc Letters PLANNING & DEVELOPMENT SERVICREG
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE APR 14 2017
...........
FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE P0LL0WJhLQ!,,
CHANGE OF CONTRACTOR—Change of Contractor is to-be signed and notarized by the property owner,
and the now 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:F11 out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Con actor.
CANCELLATION OF PERMT—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 qumliflcr of record, There is no fee for
cancellation of the permit.
Date: ,/__0
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11 Permit Number.' )I
:7q )Cc *�
Site Address na-. 0
State License SLC License
Original GC.subcontractor ol(e�e udder
tate License _SLC License
New GC,subcontractor
Reason for Cancellation OD �L,-O'CK b CC6f _4_a -(_P x(f d ()I I V/ CSJ'0)PCA
The undersigned does hereby agree to indemnify and hold harmfs�St LucielCoun i.ccrs,agents and employees from all
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costs,fees or damages arising from any and all claims of action teas n,W Ise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cahnot be ca la if ork bmu;been performed.
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F OWNtlt��,(Or 0;w��ne�Oftfldrer) _10NATU E C TRAM (Orne
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Swoofifluridd Cnantyofst-Lueie�y State o orida,County of8t,Lurie Coun p 0
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The following instrument vim acknowledged beibre me this 11CIVAng WIS do W _v.
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Jima-ft—l".0NOW-ry— t-1pote==�- S gnature of Nata Date
TONI A.ABBOTT RL�
Revised 04/1.5/1.6 Notary P0116, State of New York
Qua[. in Fulton Co. No,01AB6007260 APR 14 My
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My Commission Lx[ilros 5, 12-12