HomeMy WebLinkAboutChange of Contractorr_ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIItGINIA AVE FRCEIVED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-157 0 4 J;9ounty, Pern
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 S50.00 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: (40( BLI(oD
Site Address: —15—o3 &Ease gj�) FT Pcr occ F(, 3ttYS�
License SLC License
Original GC, subcontractor or owner/builder
SToc loc w E 12vn�u sc� I c C_ State License &C64195 '73 SLC License LOZ S!j
New GC, subcontractor
Reason for Cancellation (_- 6 IV,; L
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims of action for any reason, whi ay arise as a result of this change of
contrra subcontractor or cancellation of permit. A permit cannot be can�ll i orkjww6y n performed.
XGNAW OF OWNER (oII r owner/builder) SIGNATURE GENEIML CONTRACTOR (or new GC, as applicable)
PRINT NAME `) � 1'L tGi lY (� y�L J(GVi / PRINT NAIVE —
State of Florida, County of St Lucie County
acknowledged before me this
20_[!�, by -Sleep h.e* 1
_who is personally (mown to me
SignatureofFotary Date
GLENDAd.ROBINSON 1
Revised NOTARY PUBLIC
8 STATE OF FLORIDA
= Commq GG158884
CE 1g�� EXDIfeB 1111212021
State of Florida, County of St. Lucie County
T'b, following innscttr(uummengt was ac
0 g fo edre me this
2by
V who is personally known to
me or bash dosed as ID.
'�e'`,� (
Sig e o otary I Da (.7J
ii°° RENEE PHILLIPPE
� aa`mk Notary Public. State of Florida
Comirissionp GG 179276
My oomm. expires Mar.4, 2022