HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
2ZONING DIVISION
' COUNTY00 VIRGINIARF�,FI�
FORT PIERCE, FL 34982 ����0
(772) 462-1553 FAX 462-1578 ' �@�rUntr p�O&
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.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
C cellation 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: (Cl U Permit Number: I S
Site Address: _2)1tlp C,�)U 215 �jIUC�, �T � �--C �`-t-r -2 `T
�e cA e,�V.,CiDn 1�4 CBC-
,:15n ( z V3SSevvl State License I Ztot)9_1-3 SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor or owner/builder
Reason for Cancellation �S US C2--> �•�u ul t,-� ) e On kX
The undersigned does hereby 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
contractor/subconyr�cto or cancellation of permit. A permit cannot be cancelled if work has been performed.
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SIG TUBE Of O R(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAMES- PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of 1.4" 20W day of .20_,by
}p�w 'LWdJ'6 V r( who is personally known to me who is personally known to
who has produced �L L as ID. me or who has produced as ID.
' ly
Signature
Signature of Notary Date
MYCdM,SION#GG) 2Q21
EXPIRES:berembor t602o i
Bonded 7hru Notary Public Unde writert,
Revised 1111