HomeMy WebLinkAboutMisc Letters PLANNING & DEVELOPMENT SERVICES
' BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
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,
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-
Con ractor.
CANCELLATION OF PERMIT–The cancellation of a permit is acceptable only if no work has been done.
Ca cellation 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 Permit Number: _0,0C) – Cn
Site Address: ?)(a 6-a ncLn b r iF4 ?&c_e_., R . 3y q�a
MaLia. � —_cin'c Q I QxA (ichr State License I~CiWo I LaSLC License-
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor }}�� ` ` ,�� Ano
Reason for Cancellation �L1S�UYYIPI- CCC�I \'mil l' -I A Y,(Yl(��- hQs no 016YAeL-I
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 been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNA GENERAL CONTRAIICTOR(or new GC, s applicable)
PRINT NAME PRINTNAME �1�5 C , 1-ta�WC_
State of Florida,CountyZkd
State of Florida,County of St.Lucie County
The following instrument before me this The following instrument was acknowledged efore me this
day of _ C�day of ff iY�..Y1 ,2020by �meS
who is personally known to me �._ MST U. CL who is personally known—to
or who has oduced as ID. me or who has produced as ID.
`�M0A , I �3�aoaO
nature of Notary Date Signature Notary Date
Revised 04/15/16