HomeMy WebLinkAboutProject Information i
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ry - PLANNING&DEVELOPMENT SERVICES TT
BUILDING&ZONING DIVISION --
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2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERM[T
PLEASE SELECT O\tE 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 (51,500 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 fiI] out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Contractor.
2MHAW 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: _ 1 (.l l Permit Number: �810�55
Site Address: 2868 HARSON WAY
DONT SWEAT IT AIR AND HEAT,INC State License CAC1818236 SLC License
Original GC,subcontractor or owner/builder
FRIZZ HEATING AND AIR CONDITIONING,t_i_C State License CAC1819179 SLC License
New GC,subcontractor J
R
Reason for Cancellation i nt St 1r1 O V` 1110 C
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 permit cannot b cancel d if w Ic has been performed.
DM&�/� � Z
SIGNATLUE OF OWNER(orown /builder) SIGNATURE GENE
i.C NrRACT R(or new GC,as applicable)
PRINT NAME_Acr\ e 1y�C k f c PRINT NAME E P_i ` , ��U 0 0 0
StateofFlorida,County of5t-hmna ftp 014 &I /3eA,/H State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The Ilotving instrument was ac Ledged before me this
//�a�r t�ay of lr� ""`20 &by day of DM'�/r—'20)]Tby
IU1 ICY R1 ti Who is personally l no),,6 t tome ' U tJ wbo is personally known to
or%V"b has pr aced f—L b(--.. ID_ me or ufio pro cod as ID.
Signature of Kota» Date �a.• 8 Signature of Notary Date
Revised 04/15 16AAL'y'''•. LINOAAKLEYWEG7 turelrr KAREN S. NIELSEN
��- Notary Public State ofFtorlda ,�`: `'°La'%
�_° ��State of Florida-Notary Public
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commission ttGG20b7b0 E, +_
Commission#GG 207484
My Comm.Expires Apr 15,2022 ;;a �o� lt4y Commission Expires
Bonded through National Notary Assn. + QF'�O June 12, 207.2
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