HomeMy WebLinkAboutChange of Contractor 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 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
commencingan work..There is a$50.00 fee for the Change of Contractor.
Y g
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-
CoCNCELLATION
r.
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: 5-2 7— Z O Permit Number: &D 7` 05W
Site Address: /D 6 ;-7 aC ��)� n SL
f a� �. j / � / to G l
ri'k e t�--1-0 C�r%'c �: tic State License1_00153 0 SLC License
Original GC,subcontractor 6r owner/builder
State License SLC License
New GC,subcontractor j
Reason for Cancellation vmev becdme cio d 17 eve r ho I
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/subcontractor.or cancellation of permit.A permit cannot be cancelm if work has b en performed.
�2 ��
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR or new 6C,as applicable)
PRINT NAME PRINTNAME Pall b/`n
U
•—r
m
State of Florida,County of St.Lucie County State of Florida,County of SL Lucie County tL 3M•aN
The following instrument was acknowledged before me this PfAowing instrument was ac wledged ore me th' A w cov
day of 20_by day of—���L 2 �� z o s
0
who is personally known to me who is personally known to m T
— 0 co
or who has produced as M. me or who has produceddW o.N 3
=UNoa
QoEv,i
Signature of Notary Date Signature of Notary Date W m o 2
N
Revised 04/15/16
-r oC