HomeMy WebLinkAboutChange of Contractor I . I
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
COUNTY 2300 VIRGINIA AVE FEB 2 210181
FORT PIERCE, FL 34982 Permitting Department
(772) 462-1553 FAX 462-1578 St. Lucie County
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PISAeE 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-
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 boththe owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 0-.Ir-oD L9 Permit Number: 150 0 y O Z I
Site Address:
1 \ 3 339-0- s� -
CJh(lots LI V kQ.L / � `5 , SttateALicense 9.932.1 SLC License
Original GC,subcontYactor or owner uilder C.
)4((\Q,OUY\,{/&_ State License 11/4) SLC License-W
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 change of
contractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has •• + performed.
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SI NATURE OF OWNER(or j .er/builder) SIGNATURE GENERAL C P ' •CTOR(or new GC,as applica e)
PRINT NAME V k`tD\O ( ger5 PRINT NAME
State of Florida,County of St.Lucie County State of Florid, County of St.Lucie County VO\
The following instrument was acknowledged before me this The folio • g instrument was acknowledged before me this Gd ,� pp/���
2-',---day of t ('J 20 by CA 1(. 01:11,14 4 'ay of ,20_,by W'
who is personally known to me who is personally known to
or who has.roduced Cu- as ID. me or who has produced as ID
U 1�
Signature of Notary `1 IH,�;Lar 9 Signature of Notary Date
ELLEN VA UGHN
° State of Florida-Notary Public
'a
Commission #GG 270079
Revised 04/15/1: :11,1 leP My Commission Expires
/limo October 22 2022
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