HomeMy WebLinkAboutChange of Contractor --- PLANNING & DEVELOPMENT SERVICES �s>_"�J e s—h
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
m - RECEIVED
_-- — — FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 AUG 2 4 2.098
ST. Lucio(zountp, Permitting
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.
V 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: 8/22/2018 Permit Number: 1808-0357
Site Address• 102— 00 �
Alliance Group State License CCC 1330918 SLC License
Original GC,subcontractor or owneribuilder
State License 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 damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A per5axamud
1be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GE CONTRACTOR(or new GC,as applicable)
PRINT NAME ds P Ta' �S PRINTNAME Danielle Beggs
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
22nd day of August 20 18 ,by Zy" day of ^flUe1 .2018 by o�anos.ee.
who is personally known to me who is personally known to
444
as ID. e o h�ha ro uc as ID.
68/22/2018 8/22/2018
Date Signator of Notary Date
00 0-4 Notary Public State of Florida
Revised 04/15/16 Karolyn H LeBlanc
Notary Public State of Florida < My commission GG 224008
Karolyn H LeBlanc
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My Commission GG 224008
�+y�� ' Expires 0610312022