HomeMy WebLinkAboutChange of ContractorPLANNING & 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:
X 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: 02/6/2020 Permit Number: SLC-1910-0270
Site Address: 2504 Newport Drive, Fort Pierce
Owner Builder State License SLC License
Original GC, subcontractor or owner/builder
Sunrise City CHDO Inc State License CGC1515114 SLC License
New GC, subcontractor
Reason for Cancellation Off% Ae r S� I I Ih 9 �Dpe++y
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
contrac or/subcontractor or cancellation of permit. A permit cannot be celled i work h� been perfor e
c (/
I NATURE OF OWNER (or owner/builder) �J SIGNATURE GENERAL CONTRAIr
TOR (or new GC, as applica le)
/PRINT NAME /� {��'[� PRINTNAME Roderick Wall
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
6 day of February 20 2_ by
r C ��i who is personally known to me
o has p d ed 5L -- as ID.
` 02/6/2020
Signatur of Notary Date
��*" NotaMams
tele of Florida
Sop
Revise >yConmisaionGG23E873
M
'pia_Expires 05rA2020
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
s day of February 20 20 by Roderick Walier
whc nmm�nally known to
�ororoduce ID as .
02/as 020
ID.
Signature (Notary Date
=SWhiae of Florida
G 23ti8730