HomeMy WebLinkAboutProject Information SEP-20-2018 THU 12 30 PM CENTRAL SCHEDULING FAX No. 3212686138 P. 001
RECEIVED
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.....: PLANNING & DEVELOPMENT SERVICES
SEP 2'0 20113
BUILDING &ZONING DIVISION
C r0EIN :�;;'';< : • 23 0 VIRGINIA AVE Permitting Department
St. Lucie County
FORT PIERCE,FL 34982 •• •
(772) 462-1553 FAX 462-1578
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•
• ;CHANGE.OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
Pi.1645EITLECT 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-
Tactor.
CANCELLATION OF PERMIT-The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed qnd notarized ly both the owner and qualifier of record. There is no fee for
cancellation of the permit. i p 011-0/-l0 13 b 1-�n-09n CI-coo 18'
Date: CA\20\ 1eJ Permit Number: °"2.71C)
S. a Address^, l".aC.A Watt \ CerCe, 1 SL4 1
�i{111Mir orli rc,at&tate LicenseC ti-1bSLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor •
4 (,]�'�j_ ( _
Reason for Cancellation V1 QG i em—Cb 1 eC \ c ac
The undersigned does agree enau4 and hold harmless St Lucie Cour its officers agents and employees from all
herebyfY h'� g
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 permit cannot be cancelled if work has been performed.
G
SI OF OWNER(or owner/builderr)) a• SIGNAT CONTRACTOR(or new CC
as applicable)
PRINT NAME j( c�C k PRINT N• . �� rf
State of Florida,County of St.Lucie County State of Florida,County of St Lucie County
The following ins• ,elwas acknowledged before me this a following i shv en!was ac10 nwledged before me this
17.K.-.) day o ' ` 20\17 ,by day of ZOO�,by
who is personally known to me who is personally known to
U• ,as produced r ,was IDD.. ma wh as produced as ID•PAAL .
eirnf
clizon
Signature of Notary Date .4e5:'CCCC•• Catherine[(Q re of Notary Date
le• Commisslon# 172372
Expires:OCf 28,zp18
HDNDSb THRII
Revised 04/15/16 ��„up•`� 13TFLoRIDANO'1'Ali it.0