HomeMy WebLinkAboutChange of Contractor J ,
PLANNING;&DEVELOPMENT SERVICES
BUILDING&ZONING Dhg910N
23.00,VIRGINIA AVE
FORT PIERCE;'FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF.PERMT
PLEASE•,$ELEGT ONE OF THE FOLLOWING:-
V' CHANGE
OLLOWING:_VCHANGE 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 Cominencerrient,must be filed in the new.contractor's name
for job values greater than $2;500 ($7;500 if AJC Change-out). A recorded copy must be submitted prior to
commencing-any work.There is a$50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontractor'chan$es..are to be completed byte-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
eancellation;of the permit.
Date: 04/13/2018 Permit.:Number: 1110-0029
Site.Address:
Adam's Air Conditioning/Adam Emanuel -State License CAC1814146 SLC License
.Original GC,subcontractor or owner/builder
CB Construction and Design Services/Ramon Lalloo. State License CAC1819319 SLC License
New GC,subcontractor
Reason for Cancellation Adam's Air Conditioning has been sold to CB Construction and,
The undersigned.does hereby agree to indemnify and.holdharmless St Lucie Cotl ,t o bets;agents.ai employees from_all.
costs.,fees or-damages arising from any and all claims of action for anyreaso ww arise as a res
e of this change of
'contractor/subcontractor or cancellation of permit.A permit cannot be,p' ed:if w k s been p fo ed.
SIGNATURE OF O WNER(or owner/builder) G URE C C K(or hew GC as applicable)
PRINT NAME. PRINTNA1vIE °`
State of Florida,County,of St.Lucie County State of Florida,Countyof St.Lucie County
The follosving,instrumentwas ackmowledged.bctbre mo this g ''Qt' sac led e.me this
day of 20_,by f 20Y �_
who is petsonally.known'tome who :r_sonallylmo ao
or who has produced as ID. m or who ha roduc �s ID--
04113l2018 ` ' 4'1 18
Signature of Notary Date Sh "ture of Notary Date'
I
Revised 04/15/16
`"` .LYNNETTE.HAMILTON
MY COTi MISSION HTF94866§
.°� � 'ptpatFS]aiiiiarY07 2020
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