HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SER
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE,.FL 34982 .
(772) 462-1553 FAX 462-1578
APR 22,-2020
ST. Lucie County, Permitting
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.
11
Date: �I�'1 / `.J'1-'.fL d Permit Number: (;j(X J 1 - M
Site Address: I -I L17 Ale— I_Q.S Nyd ,.JQ.bLilt. 4Cr%"e f � 15--
K a P // kMyLx6 bl2.l S State LicenseC (eC. I Q,2 2S?C License
Original GC, subcontractor or owner/builder * ' ......
g ptfvrate
New GC, subcontr ctor
Reason for Cancellation 7-rV , Sled l nll /lam '' u,4;4 t'dr71 d ey M� 'w
The undersigned does hereby agree to indemnify and hold harmless St Lucie Co&ty, its officers, agents and employees from
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
contractorisubc� r or cancellation of permit. A permit cannot�Hed if wor as been performed.
SIGDF // (or owner/builder) GENERALS CON RACTOR(or new GC, as applicable)
PRINT NAMEy�QX QJ(Y\ J � PRINT NAME L'L---^ eR+S C+2,S7s�-C
State of Florida, County of St Lucie County
The following� instrument
��nstrumen�tt was aelmowledged before me this/�
%day or AMe..s� 20� by�jy�P�y Gtvkt5
>d who is personally (mown to me
or - has produced as ID.
2D Hoicl, 20W
Signature of Notary Data
'01JI/,,, BONNI HARRIS
:State of Florida-Nota(y Publle
Revise
d ; Commission @ GO te7875
., My commission Expires
r December 13, 2021
Stec yof Florida; County of St Lucie County (y�11
�''` r�yy/�-,�a�-�
'Y`t'Wmy of eng'ns 20 yged f tt �/ l�tl .elu—� t
MICHAEL Mel-IALE
WHALE
111'COMMISSIONK0163796
hSPIRfiS; December 17,2021