HomeMy WebLinkAboutChange of Contractor z PLANNING & DEVELOPMENT SERVICES
��` c ` '" BUILDING & ZONING DIVISION
BOUNTY _ 2300 VIRGINIA AVE
FLOREDA
111111111111111111111111111.0111 FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLE SE SELECT ONE OF THE FOLLOWING:
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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.
CANCELLATION OF PERMIT—The cancellation of aermit is acceptable onlyif no work has been done.
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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.
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Date: O9,l% 1 . 9 Permit Number: I v qi
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Sit,z)e Address: r) .� )) Pa�i c, r� A-ve.
State License / SLC License
Original GC,subcontractor or owner/builder
bint 0 CAY7/(/l State License SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does herebyagree to indemnify gn gr 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 be cancelled if work has been performed.
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SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC •pplicable)
PRINT NAME KOAcQr r PRINT NAME h. IOC &IL
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 instru - t as aclmgwledged before me this
day of ,2019 ,by Wkcefl —' o -- day of 20 ,by
who is personally known to me �P1 who is personally known to
or .0 • $roduced FL DL as ID. me.- ho has produced as ID.
Signature 'ota �.,M... �_.._,•4.., _,n._,n_.... _. ....
g ry` �,,,,,,, Signature of Notary Date
o�,''Y1 , ELLEN VAUGHN
=y° ui, v_State of Florida-Notary Public
;��'� "_ Commission #t
�'',/,°,111`6,s‘
r I li 1r ,: GG 270079
Revised 04/15/, %;111� •° MY Commission Expires
October 22, 2022
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