HomeMy WebLinkAboutUntitled t PLANNING & DEVELOPMENT SERVICES
'- - BUILDING & ZONING DIVISION RECEIVED
MOM!
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 J U L 2 2 2019
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
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,
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 both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2.2.' I -I Permit Number: V% `k 1_1 rp
Site Address: »- �IG.. �Vl '/) Lv'
—i�OoF State License SLC License
Original GC,subcontractor or owner/builder r/
d ✓( >�Y�- T.z State License�C �a y�4LC License
New GC,subcontractor
Reason for Cancellation
The undersigned does her y agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,f es or damag r' ng fro y and all claims of action for any reason,whic art a result of this change of
contra or/s ac or c c tion of permit.A permit cannot be canc wo as been performed.
r'
IGN RE OF OWNER(or owner/builder) SIG A CONTRA TOR(or new G ,as applica e)
NT NAME_ /J �/,� PRINT NAME i C
State of Florida, ounty of St.Lucie County State of Florida,County of St.Lucie County
ollowing in from nt was ac ledg bef a me this Th ollowing i m t was ac ledge befo a me this
day of 2 A by day of 0
who is p rsonall wn to me wh 's personall wn to
or who has produced as ID. me or wh roduced as ID.
a u tary Date Signatur otary Date
Revised Y
�.►s" Notary Public State of Florida lef Notary Public Sate of Florida
Trisha Neal Hutchinson Trisha Neal Hutchinson
cMy commission GG 1411949
Z9 MY Commission GG 148949
a� Expires 10/01/2021 orwo Expires 10/01/2021