HomeMy WebLinkAboutChange of ContractorPLANNING & 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
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: Loh ILca Permit Number: :�m Y — Wc;i (p
Site Address: 7 0_7 i 1 ,r VC, CC Cl_..
G1Q 1dS1C_1- Ele.✓j-nC, State License F130���SLC License
Original GC subcontractar r owner/builder
1S LIc_-C Y 1C' State License EO—CM 151.09 SLC License
New GC, subcontractor
Reason for Cancellation C 1Q�Q` �, (� ej'e C+n co -1 Cc, n- T o-ci-0 P
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 a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be c elled if r c ha erforme
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME V�IC Ll- `
�x - -taV 1 {rl
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following ixtstrument was acknowledged before me this The following instrument was acknowledged before ane this
day of ,.),t -nl - 20Y_� by ,�\1'-CJ rC_LJ
N(a (4 Cd," F-) who is personally known to
day of 20_, by
who is personally known to me
or who has produced as ID.
Signature of Notary Bate
Revised 04/15/16
me , who has produced as ID.
Signature of Notary Date
�g..kV ¢WG�- reier
Cammiss�la SB
on SGG030843
Expires: September 15, 2020
Bonded thru Aaron Notary
PERMIT 12-C-0� 0O1111E DATE �n l 12
I 2jo
PLANNING & DEVEL[)1"MENT SERVICES
Funding & Code Compliance Division
1� p
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
`—` ' I N t I I(- . have agreed to be
(Company NamelIndividual Name)
the (f-- � C�CA-V:A LAW Sub -contractor for i✓2 200C)
(Type of Trade)
(Primary Contractor)
For the project located at a�( CSU C0r \A,,
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice,
i'TRACTOR SIGNATURE (Qualifier)
ncA�-e-") N
PRINT NAME
l 7)l ?)to-,
COUNTY CERTWYCATION NUNTBER
State of Florida, County of SA- LJU C -A )L�
The foregoing instrument was signed before me this day of
Jvne zo�y
who is personally known'kor has produced a
SUB-CONTRAGTORSIGNI ATO (Qualifier)
PRINT NAME
IC)�92
COUNTY CERTIFICATION NUMB/E,R�
State of Florida, County of S+ L.C) L
The foregoing instrument was signed before me this // day o€
JL !2L- ,20s� by C -d WOXJ JUfU
who is personally known V or has produced a
as identification. as identification.
pal-t&s
STAMP AR -b S
, L�� Signature of Notary .Poh ' _ Signature of Notary Pu lic STAMP
Paula 9, 8v -e,^ -r
Print Name of Notary Public hirejer
Punt Name of Notary Public
�`��r.'?z. Paula S, Breier
,�. ��`•oke4 ?�s� . Paula S. Breier
z, Commission # GG030843 �'�. Commission GG030843
Expires: September t5, 202C} *' '�= Expires: September 15, 2020
Rer•ised 11116/2016 -< o� ,a�' Bonded thru Aaron Notary�`'� 01 ��;��' Bonded thru Aaron Notary
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