HomeMy WebLinkAboutProject Information PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVEIVh
FORT PIERCE, FL 34982 MAR 0 3
(772) 462-1553 FAX 462-1578
S?. Lucie County, Permico::;,
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: Permit Number.3
Site AddressQ,3 oQL �L1`l
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation doQ
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 CO CTyOyR�(or new GC,as applicable)
PRINT NAME PRINTNAME.t� r3 � _ C a! //JI 21
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this I�following r e was ackyq_vled b�6,,,LK
day of 20_,byJ day of� 20Y�by
who is personally known to me wh pe ally known to
or who has produced as ID. me or who pr u as ID.
- [
Signature of Notary Date Signature of NM mo-i
KAREN S. NIELSEN
;State of Florida-Notary Public
Revised 04/15/16 '_ Commission # GG 207484
My Commission Expires
June 12, 2022