HomeMy WebLinkAboutChange of Contractor i
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PLANNING & DEVELOPMENT SERVICES
- - - BUILDING & ZONING DIVISION
o -
2300 VIRGINIA AVE
- FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-15,78
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,
a d t e 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.
Cancellation of permit is to be signed and notarized by both the owner andqualifier of record. There is no fee for
cancellation of the permit.
Date: ,b �� Permit Number: �.�, 17�_
Site Address: g Dai J' c,T es P�e��� I-I-�nGt�- 3 9Jr�
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,L�yV-i� �,:► 4 C'x'�_ State License SLC';License
Original{{GC,subcontractor or owner/builder ��
Fr&AC. ��Jos State License i33(WZSLC License
New GC,subcontractor
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Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,,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/subcontractor or cancellation of permit.A permit cannot be cancelled' w r has;bee formed.
p Elob711011,� d
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CTOR(o GC,�as applicable)
La.0 n� a s-{-��00d
' PRINT NAME PRINT NAME I
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The follpwing instrume t acknowledged before me this The following instrument was acknowledged before me this
�n ddday of 06 by La-LLr1`P_ day of 20_,by
who is personally known to me who is personally known to
r who has produced// as ID. me or who has produced as ID.
Signature 4 Notary Date Signature of Notary Date
�tgY Pie MELINDA ENDRES
2°. -• �% i
Revised 04/15/1* MY COMMISSION#GG M219 �,,.��Y�''. LASHAHNA INGRAM
tna �a
N„ c� EXPIRES;May 21,2021 :2°��`�= Notary Public-State of FIOr1da
�TFOF F`oQ� Eonded Thru Budget Notary Servicesw * My Comm.Expires Dec 20,201
°'� CommiSSlon#FF 177249
Bonded through National Notary Assr