HomeMy WebLinkAboutChange of Contractor p = PLANNING &DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
I
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 theProPertY 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 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 and qualifier of record. There is no fee for
cancellation of the permit.
Date: I I Permit Number: 1 l0
Site Addre 3605 SLOAN RD
State License SLC License
Origin ,subcontr r or ownerlbuilder
HYER QUALITY PLUMBING LLC State License CFC1427856 SLC License
New GC,subcontractor
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 dam ges arising from any and all claims of action for any reason,w ' h may arise as a resull of this change of
contractor/s tractor or carrell im of p 't.A permit cannot be cancelNd' k has e Ittred.
SIGNA E F OWNER( er udder) SIGNATURE GENE CONTRACT R(or new GC, applicable)
PI2IN AME SHAS HEMANG PRINTNAME JOHN HYER
State of Florida,County of StLucie County State of Florida,County of St.Lucie County
Mf ins tIgn�ivas 20 owl bg b fore me this lowing instm w 'acmledged b e_mp th
y 1V,� IIday11 of y
personally known to me �T�Q_ who' personally known to
'or who has produced as ID. me or who has produced as ID.
PETER NUNEZ
Signature of Notary Signature o
PETER NUNEZ Signatf Notary S
, NOTARY PUBLIC
NOTARY PUBLIC STATE OF FLORIDA
STATE OF FLORIDA oiComm#FF189093
Revised 04/15/16 ` �' Comm#FF189093 INCE19Expires 1/12/2019
`�i �e�0 Expires 1/1212019