HomeMy WebLinkAboutChange of contractor PLANNING & DEVELOPMENT SERVICES
T ' BUILDING & ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
FLORIDA — '
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,
an 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: 1,12-9 ( l - l Permit Number: I W V53
Site Address:
Ne State License (O8-71 SLC License
Original GC,subcontractor or owner/builder
H/0 State License o A
. (A- 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 c •nge of
ontracto/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
y1
SIGNA • OF OWNER�= (orZwner/buil r) - / SIGNATURE GENERAL CONTRACTOR(or• GC,as applicable)
PRINT NAME I) A//)44 L;y////(/ PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of S ucie County
The following instrument was acknowledged before me this The following instrum-• was acknowledged before me this
_day of SA.,—) 20f3_,by FL Lb-y/0;4 day of 20 ,by
who is personally known to me �f who is personally known to
or who has produc PL- ID. me or o has produced as ID.
QUAl
Signature of Notary Dal( Signature of Notary Date
,a,oa'd?,,, ELLEN VA U G H N
Revised o4/ 93'�.n°r 4*:State of Florida-Notary Public
Commleblon # GO 270079
'i-mtl`° My Comrniaeian xplree
TQotober 22, 2022