HomeMy WebLinkAboutMisc Letters i � I
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
OUNTY
2300 VIRGINIA AVE. i
FORT PIERCE, FL 34982
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(772) 462-1553 FAX 462-1578
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CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
i 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 recoided 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 toi 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.
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.
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Date: /// /'IV/7 Permit Number:,Sk !7a , - 6 0_�,q
Site Address: 3//0
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor or owner/builder
Reason for Cancellation
The undersigned does hereby agree to inden6lify and hold harml, s 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 if work has been performed.
sidN,kTbKt
s F (or ownewilder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME � S PRINT NAME l
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State of Florida,County of St Lucie County State of Florida,County of St Lucie!County
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The following instrument was.acknowledged before me this The following instrument was acknowledged before me this
day of Na 20 1 by day of 20 ! by
U) ' who is personally known to me who lis personally known to
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0 o produced as ID. me or who has produced as ID
OSi nature of Notary Date _ _ Sjgna - Notary 'Date !
LASHAHNA I�lGRAM
`O'`aaY n�B''•i -
��a Notary Public-State of Florida
Revised 05/18/2017 My Comm.Expires Dec 20,2018
Commission ;`FF 177249
/''!F I ;`+�' Bonded through National Notary Assn.