HomeMy WebLinkAboutRoaf changePLANNING DEVELOPMENT SERVICES
Building & Code Compliance DIVIsinn
Company Nameflei&i d-ua.l N,
the
(T)Te of rade)
For the project located at
BUMOzNG PERMIT
SUB
-CONTRACTOR AGREEMENT
C have agreed to be
sub -tractor for
C' ri=ry Corm actor)
Street Address or Property Tax 16 4)
It is understood that, if there is any change of status regarding OuTparticipation with the above mentioned
project, the Building al -id Code Regulation Division of St_ Lucie County will be advised pursuant to the
filing of Change of Sub -contractor notice.
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PRIM, NAME
C—CaC _ ._ 62
BOUNTY CERTIF Y N NUMBER.
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Stam 6f FljI rids, County
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COUNTYCERTIFICATION Kb`iOPR
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Signature of Notary Public
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iPrintl4ame ofNgtary Public
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NOTARY PUBLIC
S f ATE QF FLC)RIDA
comp -4 GGiu8377
Expires1512612021
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COUNTYCERTIFICATION Kb`iOPR
st'�te of riorStla, c4�t�tk ad' CA �' �-i
TIT foxe;;aiu8 ins#rutmeot was - ned before inc titis4 day of
who is persanaiiy Imawn _)LOur has Produced a
as idettriCrcatian.
STA
Signature of Notary Public
Mat F-�V eN
iPrintl4ame ofNgtary Public
*40�
Arfianda -Allex
NOTARY PUBLIC
S f ATE QF FLC)RIDA
comp -4 GGiu8377
Expires1512612021
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING I3IVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34952
(772) 462.1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT QNE Cl; THE FOLLOWING. -
CHANGE GE Q CONTRACTOR —Change of Contractor is to be signed and notarized ley the property o",ner.
and the new contractor of record for the current perrrait_ A new permit application roust also be completed witli -new
contractor in.forination and signature- A new Notice of Commencement must be filed in the new contractor's name
for job v.alues greater than $2,500 ($7,500 if A/C Clmge-ou.t)- A recordQd copy ,€rsi be sub -witted prior to
cornnpncing any work. There is a S50M fee for the Change of Contractor.
V CHANGE OF SUBCONTRACTOR -- Subcontractor changes are to be completed by the general contractor.
The t}eW subcontractor must fall out a Subcontractor Agreement Forret. There is a 550.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has peen 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:' f' f ^ 2
r�
Site Address:��
Permit Number:
� r t}-"/ L=n State Licensed ° = L SL License
�U-��eibcontractor or owner/huiIder {
Lice eState License -.
New WLSubcontractoi", jI/ �4
Reason for� f!° !� � � 1� �� 1 xe.='L?/ 1,6 "'i �ts i � �' � � �l i �wi£ f � �'� P � �'yf �✓ �'/ f f �
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and ennployees from all
costs, fees or damages arising from any and all claims of action for any reason, which may anise 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 OLi ti ] R 4 rierft�uildor) SiCrNA 1 YRE GENERRAL CONTRAC"rQIZ Or new GC, as applicable)
ieTrlm NIAJAE PR1NL T DAME r f 4: � f � • fj s t !f'i `;.rr
State of Florida, County of St. Lucie CMMty
The, fof[Ming instwMent was wknowlrcaged before me this
-day of 24_ _ . by
who is personatlyknozcn to nxe
or --ho Ims pro uced ,.."_„`as ID,
Signature of Notary Datc
Rev sed 04/15/16
Stale Of Rorie County of St Lucie County
1h 4it�w7nginsi
e�#gd int fere this
7f siayat I ?fle 6 s� �p by •- te/-71 D.
me or who has produced
Signature of N DIft
0 Not" RMC SW* d FAMIS
My Cwt GG 280148
Nor E po. i1rIaixa22