HomeMy WebLinkAboutMisc Letters PLANNING & DEVELOPMENT SERVICES
o.� BUILDING & ZONING DIVISION RECEIVED
OUNTY 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 OCT 0 2 2017
(772) 462-1553 FAX 462-1578 PERMIT-1":-:;
St. Lucie County. FC
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 signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor.There is a$50.00 fee for the Change of Sub-Contractor.
KanceANCELLATION OF PERAHT—The cancellation of a permit is acceptable only if no work has been done.
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nn of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2c IV1 Permit Number: T ( Q O
Site Address: t b 1 I ��I� N ►�1(.
1 �1(n X'Z l,L! � ,P, State License SLC License
Original
GC,Isuubcbntractor or owner/builder
_ State License SLC License
New GC,su contractor or owner/builder
i � L
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St,Lu�c} ounty,its o c s,agents and employees from all
costtact /
damages-IF isi om any and all claims of action fo�y r ras n,whi y a se as a result of this change of
conbcontr ct r r c llation of permit.A permit ca of b nce d' or a bee performed.
SIGl ATURE OF OV$EA,(or.own r/builder) NATURE G RAL CONTRACTOR(or new GC,as appli�Cable)
PRINT NAME' -,/F/f,(� VOIVP PRINT NAME' _e-01_19� �l
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following' e was acknowledged before me this ollowing i e t was ackno edged before me this
day of�20�by day of 20 by
1 1� '_w.0 is personally known to me A�S who is personally known to
or wh has pr ped as ID. me or o has puced ID.
A A 44 5 � I�0,U,- !�
Signature of Notary Date Signature of Notary D
KARFN
Commissia NIELSEN
�1 ` Foc #FF7
pun.i• � -�.� my COmmissi 15637
.� .,;,: KAREN S. NIELSEN June 12 on Expire$
Revised 05/18/ Commission # FF 115637 2018
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M Commission Expires
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.`,;......�� June 12, 2018