HomeMy WebLinkAboutchange of contractor 07/14/2017 15:21 7724663737 BOYLEAC PAGE 02
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I PLANNING & DEVELOPMENT SERVICES
tie; BUILDING & ZONING DIVISION
2300 VIRGINIA AVE Of
FORT PIERCE, FL 34982 / 1
(772)462-1.553 FAX 462-1578
44
CH GE OF ONTRACT R JBC iVTRACTOR CA CEL TI N O PE T
--.v/--CHANGE OF CONTRACTOR—Change of Contractor is to be signed
and the new contractor of record for the current ermit, A new and notarized by the propt rty owner,
P permit application must also be completed with new
contractor information and signature. A new Notice of Commencement roust be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Changc-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 siped by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Foam which is signed by both the contractor and
subcontractor.There is a$50.00 fee for the Change of Sub-Contractor.
CANCELLAVON OF PERMIT—The cancellation of a permit is acceptabic only if no work has been done.
Cancellation of Nrmit is to be signed and notarized by both the owner and qualifier 01'record. There is no fee for
cancellation of the permit.
Date: 11141 Permit Numbor: I V
Site Address:
ALLJAW=NQ!4 W11" 11 We License SLC License
Orig GC,subcontractor or owner/build
E*
r
W l*� , ' W ��a I State:Licensee SLC License
New 6C,subcontractor or owneYbuilder
J Reason for Cancellation Ousihm ,{SSit ,7 t 1 (f►'` 1 ''� 11 y� 1►fAU V i '
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agent;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/s cont for or cancellation of permit, A permit cannot be cancelled if work has been performed.
SI(iNA :OF OWNER(or owne iffier) SICiNATURl (iF.:NAT.;[RA)`I-CONTRACTOR
Q(or new C,C,ue applicable)
PRINT NAME PRINtNAMli '-4ILYlA�� CJ �,rI
State of 1•lorida,County of st, ucie County U State of Florida,County of Sl'.Lucie County
The following instrument was acknowledged before me this The fUlimving invt ant wBs acknowledged beforeme this
day of t 2i)1..,by — 1, J�_daJy off Qu 144 --�
_ s personally known to r`�C Q,` i. t+dy 1& who j(Z,,anally knclwa�
or who has pa)ducezl��__�M I�as ID. me�u w o bas producad as E—�
41gnature of Notary Date Slgnaturt of Notary Daft 7/1y/17
CHRISTINE J.CONWELL CHRISTINE J.CONWEt l
Itery 3 a i��y'tromp•tkett0 of WNit `�",1'��
cotttiMeelolt�00 Of 7639 Notary Public-State of Florida ,
Mfr Comm,Ellpet Aay 21,2020 commleelon#tis 017039
Ooetted lhra*Ne WS WIFY A111111. My Comm.t ttpiree Aug 21,2020
'" pw*tl tnrougn Nalwal NOINY Merl,