HomeMy WebLinkAbouthppscan72COUNTY
F L O R I D A
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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 AC 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 ne subcontractor must till out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Cont actor.
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 and qualifier of record. There is no fee for
cancellation of the permit.
Date: 10/10/2017
Permit Number:
Site Address: X605 Winters Creek Road, Palm City, FL
Miller's Central Air., Inc.
State License CAC058675
Original GC, subcontractor or owner/builder
New GC, subcontractor State License_—_
SLC -1704-0485
SLC License 19-381
SLC License
Reason for Canccllation Homeowner canceled work
------------
The undersigned does nereov 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
contract .sub or or cancellation of permit. A permit cannot be cancell
s been performed.
PR I TURE OF O\NNE er/bu j
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PRIM? NAME PRMTNAME. -6 Q&
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