HomeMy WebLinkAboutProject Information PLANNING & DEVELOPMENT SERVICES
BUILDING &ZONING DIVIS RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 AUG 2 20'8
(772) 462-1553 FAX 462-157
ST. Lucie County, 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-
Con ractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
ancellation 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.
a
Date: Z��/� Permit Number:
Site Address: 6_vG- i
��uS CoeC�,Z" dO(\, GL1_-_ State License 6CX_1-3 Z1 ZZ6LC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor i
Reason for Cancellation W—q- i�-j Sly\
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
con a or/subcontractor o,P,cancellation of permit.A permit cannot be cancelled if work has been performed.
GNATURE OWNER(or owner/builder) SIGNATURE GENERAL CON RACTOR(or new applicable)
PRINT NAME !P(. PRINTNAME (�V
State of Florida,County of St.Lucie County State of Florida,County of St:Lucie County
The ollowing instrument was acknowledged before me this The_lVlowing r frame t was acknowledged befib me this rr ll
day of 20�,by�c1H �
C!\V dayof 20 b
� .
{ o kl Y\ who is personally known to me who is personally known to
or who has produc !-\- `' as ID. mer �hasprod�ucedq as ID. . .
EANNAUtRIE GIVENS
Signa D
E�' tt�y Signature of Notary Date
MY COMMISSION#GG 022023
= ro,: EXPIRES:December 16,2020
Bonded ThruNotary Public Undonar)taro � Kimberyn M.GarW000
Revi &,
Commission#GG17542-
Expires:January 16,202'2
Bonded thru Aaron Notary