HomeMy WebLinkAboutProject Information PLANNING &DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
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 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;
Permit Number:
14a I p i ne )_J0 k es V(d
Site Address:
lei L+�q'
c License SL_C LikDcense
Original GC,subcontractor or owner/builder
1—
State License _SLC License
New GC,subcontractor
Reason for Cancellation WOW, Ne-Ver-
The undersigned does hereby agree to indemnity 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,w se as a result of this change.of
contractor/subcontractor or cancellation of permit.A permit cannot be cane een performed.
SIGNATURE OF OWNER(or owncr/builder) SIGNATURAGH AL c Vrp R(or new GC aWsa pocable)
PRINT NAME PRINTNAME
Statc ofFlorida,County of St.Lucie County State offlorida,County of St.Lucie County
rl
The fallowing instrumcnt%vas acknowledged before me This 11owing entuwackppled ged e
ret t0k4d
day of tv. 201
day of 20�by
--who is Personalty known to me who is personally known to
or wbo has produced as To, me It r' uc M.-N_ ..
Signature of Notary Date out of 1� tar?
Date
-Rovi'sed 04/15/16 mm'-�VARTAK AG-U
W(;OMMWO%#C-�5
sw EVMS:Math 9,2022
...... Bonded
Bo�
Public L%&Wxbm
Tlwu