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A PLANIYnvC&DEV-,E— ENT sERv�tc_ s
$UtJDING tYG ZONING DI"SION
2300 VIRGIIVIA AVE
FORT PIERCE,FL 349$2
T. (111).462.4553. 'FAX 4,62.-1579,:
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CHANGE OF CUNTItACTOR SJBCUN'TRACTOR 4R CANCELLATION OF PER1ViT
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PiEAM.SELEC-T'ONE OF THETOLLOWING
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'CHANGE OF CQNTRACTOR Change of Contractor into be szgned aud:aiotarized byrthe property.awner;.
{ I arid`ihe.new contractor o zecozd for ttae,current p&itdt,A;new peM*.., appli atit)n;:must also � completed with new
I contractor'infor�nahon.and signature A new Notace.of -,pg mencement,must be filed anthe Aew::ccintractoz's name;
for lob.values greater than $2;SU0 ($7',500 if A/C.Change-out}. A recorded Copy,-must submutted pngr;;ti►
commencing any work.There is a.$SO.QO fee'for theChange of Contractor
CHANGE UY SUBCUTiT tACT(JR.—Subcontractor changes:are to'be:completed by ttte general contractor:
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The new subcciitractor"must fill out:a Subcintractor,,AgreetrientForrn:There zs a$56000 fee-fo'.''tlie'Change of.Suli-
l Contractor
'COCEI,I,ATIOLY:OF PERMIT Tlie ca lcellafaon:of a permat is;accegtable Daily tf njo Work has•been>done:,
Cancellation of permit is Yo'be.signed'and notarized by both the vv�mer and<gualifier of xecorcl.'Theire is no fee for
-cancellationof the-permit
:Date: 10- ; Vk P,erinif>l�It�mber;
i<te Aiidicess« f`
.. State;Lacens&_rte t 6-�O SLC Lac nse
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4riguial GC,stibcantractor or'ownerllual•`der
State LaeenseSLC License..
New GC;subcoritzactoz:
iReasonfor Caucellatioti 1 .�� � -
The undcrstgned floeshereby agree to u►demnify and hold;id'it,ss St Lucie County,its officers,agents 'emplo}iees fro nail
costs,fees oz dauiages;ansing from any and all,eTaims.of action for any reason,which mayanse as a.resulf this change of
contractorlsubcontracfor of pgrn lit.&,.permit C,., t lne,c$iacelled i#work has been pierfa._ ed.
SIGNATtJREOF OWNEat(orawneribuiIder)., SIGNATCRLE GENERAL CONaItACTOIt(otacw GC;?as app]irdfite)`_
PRINT NAMEL^ i(1 1'1iiNTNAME
C .State of Flonda,County of Stl:ucie cotmty State of Ftnri&,Cauniy df St.Lucie County
The foltoiving mstcum*4 v as,,acImowledgc a me me'iliis Tho followrag instrument wos acimowledgeit before`me Phis l
dayof 2U :by
Yof �,..
. . who ra oersoiiallvamowa ti)me QQ>>L Q cY�sC fJ tivhp is jiemonaltvknowa_to
orwho`has pmducd' as'7D. t>i arc who bas.produceil-
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trot of Notary Date tare of Notaryllak l
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io su�rr(`t�. ;IAA E L HARWR E
Renased' lr�f16 ,fAIAIE.t,tiARNEat r.,;Y, _ ....., ;
« 6tY riOMNSSiON if t3G Ot�i22
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7 * EXPIRE$Apt l2i 2021" '�oFA"'FtoniMl Tilnt Budpl N011ryi$1ivI015
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