HomeMy WebLinkAboutLAMB - SANDOW CHANGE OF CONTRCTOR FORMauNTY
P L O R l V R
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERNIT
PLEA/SE SELECT ONE OF THE FOLLOWING:
J 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:
Site Address:
5a9 av
450 S NARANJA AVE, PORT ST LUCIE, FL 34983
WILCO
Original GC, subcontractor or owner/builder
SUMMERLIN'S MARINE CONSTRUCTION
New GC, subcontractor
Permit Number: -:;)L 00 1 - CDG �(__t=
License SLC License � Cj 115
License SLC License 24217
Reason for Cancellation
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/ ubco actor or cancellation of permit. A permit cannot be cancelled' work has been performed.
SIGNATURE OF OWNER(orowneribuilder) SIG I A- RE ENERAL ONTRACT (or new GC, as applicable)
PRINT NAME (� �l•J�nkG� �M PRi4NAME JOY S YANCY
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
29 day of rnP`I 20_Z- la(- -
�. 0 & who is personally known to me
or who has produced as ID.
,P 4---
Signature of Notary Date 5 S 7�0 zA
RUSSELL COMBS
Revised 04/15/16 =r � • �: Notary Public -State of Florida
_•; Commission u GG 061589
=�9r Pi My Comm. Expires May 5, 2021
0'
Bonded through National Notary Assn
State of Florida, County of St. Lucie County
QThe -following following i trument was acknowledged before a is �� /
Iday of � �0`�Cby �CU f Q-C\ L
who is personally known to
me who has produced as ID.
Signature of Ngtry Date
Notary Public State of Florida
Ginger P Hester
My Commission GG 330259
R
Expires 08/25/2023