HomeMy WebLinkAboutChange of Contractor PLANNING& DEVEL PMENT SERVICES
BUILDING& ZONING IVISION
* 2300 VIRGINIA AVE
FORT PIERCE,FL 349 2
(772)462-1553 FAX 62-1578
CHANGE OF CONTRACTOR SUBCONTRACTO OR CANCELLATION OF PERMT
i
l PLEASE SELECT:ONE OF TIE FOLLOWING:
X CHANGE OF CONTRACTOR-Change of Contractor is o be signed and notarized by the property owner,
{ and the new contractor axrecord for the current permit.A new pe it application'must also be completed with new
{ - --contractor information and-signature.-A new-Notice-ox=Commence ent must-be-filed-in-the new-contracto?s-name--
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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 C traetor.
CHANGE OF SUBCONTRACTOR-Subcontractor char es are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Fo There is a$50.00 fee for the Change of Sub-
Contractor.
-7851 'CANCELLATION OF PERAUT-The cancellation of a p emit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized.by both the o er and qualifier of record.,There is no fee for,
cancellation of the permit.
Date: . 05//15/18 Per it Number: 18040221
Site Address: 7851 WHITE ISIS LANE
treasure coast concepts inc State Licens ccc1330362 SLC License
Original GC,subcontractor or owner/builder
Treasure Coast Roofing LLC S icens ccc1330653 SLC License 29843
New GC,subcontractor
Reason for Cancellation no longer wise to do business with Treasu a Coast Concepts inc
The undersigned does hereby.agree to indemnify and hold harmless St Luc County,its officers,agents and employees from all
costs;-fees-or-damages-arising-from-any-and-all-claims-of-action-fer-any-rea on,--,t�hieh-may-arise-as-a-result-of this-changM-of—
contractor/subcontractor or cancellation of permit.A permit cannot he celled if work has been performed.
!I SIGNATURE OF OWNER(or owner/builder) SIGNATURE ENERAL CO R(or new GC,as applicable)
PRINT NAME*Jar jt,g uLJl � PRINT •%®--
State of Florida,County of St,Lucie County State of Flori County of St,Lucie County
T}he following ent was acknowledged before me this followin instrument was aclar wledged before me this
G_1_dayof LA 20 byday 1 M by
who is personally known to me Qtr�'� `�`'� whersa :mown o
P Y
or who s produ as ID. me or who aced as ID.
" 05/18/18 $'tg
i Si re o Date Slgn f ` to Date
ROBERTBRUNKE ROBERTBRUNKE
it. Notary Public-State of Florida Notary Public-State of Florida
Revised 09/ sr 6 " Commissior. GG 176972 •. Commissior,#GG 176972
''•�CF r^ C`,�`tv Comm,Expires May i2,2022 �-`�} -" "h1 Comm.Expires May 12,2022
F Banded;hroughNadona:NoayAssn, '9cF y
Bonded through Nadoro Notar/Assn.
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