HomeMy WebLinkAboutMisc LettersPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982.
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
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.
��anc_ellation 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: -2� I Permit Number4 :
Site Address: 3a7 [ A ` A I&I 1+- '30 1
�2 WVV%e. 7D 0� �Ck\XO-\ &OMW State License SLC License
Original GC, subcontractor or owner/builder
State License
New GC, subcontractor
Reason for Cancellation
SLC License
The undersigned does hereby agree to !Pdemnify and hold harmless St Lucie County, its o kers, agents.And employees from all
ees or ages arising y and all claims of actio any ason, which arise as a salt of this change of
contract /su ontracto ation of permit. A per t cannot be ancelled if has be performed.
SI ATU (or owner/builder) SIG E CONTRACTOR (or new GC, as applicable)
PRINT E g4a146I AYI'n0� PRINT NAME_ I�a�u�' S�°`r%`^.Af-
State of Florida County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_&P—day of�, 201 . , by A "t SwAnre�l
_
who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/ rPU'•-
TIMOTHY R. O'MALLEY
:•.�,':,: MY COMMISSION # GG 117135
EXPIRES: August 7, 2021
".F
pt°� . Bonded ThryNotary Public Underwftrs
e following inst.Mm m -t was acknowledgedbefor �e this
day of� 201 by ut�) wQ"nLi—
is personally known to
me or who has produced as ID.
.�
Signature of Notary Date
Yoi%'••, TIMOTHY R.O'MALLEY
-
„ MY COMMISSION # GG 117135
=m;�a;? EXPIRES: August 7, 2021
p,, Bonded Thu Notary Publlc UnderwftrM
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