HomeMy WebLinkAboutChange of Contractor 05/13/20 07:55AM EDT '8664807498 ' —> 7724621578, Pg 4/4
PLAN �DEVELOPMENT 1C SERVICES
BUILDING&ZOILNG DIVISION
M . 2300'r'1RGWIA AV
_...:. .:.........._n.,...:..... .. FORT PIERCE..FL 34982
(772)462-1553 IFAX 462-1578
CHANE-E,OF COIF TRACTOR,SUBCON TRACTOR OR CANCELLATION OF PERNILT
PLEASE SELECT ONE OF THE FOI.LC)Ar71NCT:
CHANGE OF CONTRACTOR—Change of Contractor is to be sitr ed and notarized by the property owner,
and the nein contractor of record for the current permit. A nes;'permit application must also be completed with new
contractor in#otmation and signature. A neti>;-Notre of Cormnencemen: mutt 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 woKk-There is a$50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontt motor changes are to be completed by the general contractor.
The new subcontractor must fall out a Subcontractor Agreement Form.There is a 55M0 fee for the Ch2nge.of Saab-
Contractor.
CANCELLATION OF PE —The cancellation of a permit is acceptable only if no work has been done.
Cancellatlon of permit is to be signed and notarized by both the owner and qualifier of record.There is no fee for
cancellation of fixe permit.
Date:
Site Address;
State License SLC:License
Original CSC,subcontractor or oliner/builder
�t"t"A>r Fj eG t^°1 R 14k,' (2 State License E6/?&f%Mc��'�SLC License '~
New GC,subcontractor J
Reason for Cancellation
The undersigned does hereby agree to fndernnify and hold harmless§St Lucie County'its officers,agents-and employees from all
costs,lees or dafnages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor.,s .o�or or cancellation of permit.A perinit cannot be cancel d if work has been performed.
-'§IG\4•GP.EDF OV.•WM for 0Kner797uiidcr) T1C7M,%T rM GEIPRAL /
C�/ONTRAC OR(oar neer GC,as upphceble)
PRINT 1 _rir- _ l'�f J J PRFgTNAMC v d`�� •-, i P' SQL
State ofFloridt:,County of St Lucie Count State or F iorida,County ofSt•Lucie County
"Ihe f,lto.inY ins�tnurn nt etas aeknow ledged baI'a a mo this 'the folio mrx insttuntent vas adatowl edged be;ore the this
ay
c,? f f_ca;1�6 t 2G�by_
dr"ofuva
� aito is pa-scnanylrox;ai to me �;ho i_ xrsonaliy 4Tn4�`o
or wito has produced as U me 'i dro has P-toduced as iD.
Signaterc of?tietary Datc Sigtaturc ofNotary D c
" NICOLE BRATTON
; r.
_State of Florida-Notary Public °'y,., GINA h1.KENYON
Commission is GG 215229 tmwv Public-Slate of Floticra
iN
-,�� c`o. My commission Expires -
•;. �;;• ,t•- Cntnaussion a 0G 015542
May 07, 2022 „v Ctxnn 'c%:prts5 Jul 25,2020
K•ui=a msn.
05/13/20 07: 55AM EDT '8664807498 ' —> 7724621578 Pg 3/4
PERMIT ISSUE DATE
i L
-ELOPIVIENT SERVICES
Building & Come Compliance Division
.t, 4
C2 C BUILIDING FL�I�tN7UT
rE
—— ?^o (jS iCr � G�F�L adf fine, have agreed to be
(Company\ame/Indh idual:j-ame)
the _ ,�-_ l�GtE.C' Slab-contractor for
,' ypr.ofTt-ade) (Pzimary Contractor)
For the project located at V$Q`� ( ��
{Project Street Address or lyroperty Tax ID r) �—
It is understood that,if there is any change of status regarding our participation vvith the above mentioned
project the Building and.Code Regdiation Division of St.Lucie County-,vilI Ise advised.pursumt to the
tiling of a Chane of Sub-contractor notice. ,
f/
nom°;.,:•-`��_—____ ///�
•C(J\TRrti`CtOR SiGNA'rL>Iti<;(Qualifier) St!13-COi IGTOR SIGNATUdr(�Q�nfirti5cr)
,sl
PRI k F 1AtiiE PRINT Nv�AUE
LG120z'7
;ffo ,ry ,F.I:,.Inca 'I it 4li F4� COUIN7 •CWHFICATION'I IURIBER
State of Ftarida,C auaiy of ii•'fes�� State of Florida.County of
The foregoing instrument VMS Signed before me this The ituy of � The foregoing instrcm entcsas signed before me this�day or
240.by by
who iz•persuually bas produced r. who is r has produced a
a%identificalion. RSi ^ntlhcatian.
Slgnatureof\dtaryPublic Sin�na^tnrcof\otar}Public
Lt �.,. �,l° —
Priat Name of Notary Public Print\sme of Notary Public
NICOLE BRATDF'
ya�RYa�;�� GINAM.Kt-a':'Gn,
?° t:State of Florida"Not2 " sod lJatary Public-Slatu UiF'eita,? jCommission #GG commission N eG 01s54Zrig.•:,;,�y � flMy Commission E �,� My Cotnm.Expires Jut 2g,2020May 07. 202 '� ,
Bonded thrnagi FtattOnai hota:y ssn i�
" .3