HomeMy WebLinkAboutchange of contractorPLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
JAN 13 2019
ST. LuckCo� rmittng
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
co mencing 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: /- / 3 - ;� o
Permit Number: ./ 7 OS — OD O (5,
Site Address: LI(): F 15RV 4 U pi h f.( i IY
/i'i/ - 7o -i' c lr�G7Yl L State License SLC License
Original GC, subcontractor or owner/builder
S4 (nJ / fi^J G 1/1C. State License SLC License i (9 C7-7 /
New GC, subcontractor
Reason for Cancellation
G
M
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 cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNkTURE &NERAL CONTRACTOR
ON rC jTOOR (or new GC, as applicabl
PRINT NAME PRNTNAME C' GI-ts'-I' _s/G`S' `e/U �• l
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
_day of 20_ by
who is personally known to me
or who has produced w ID.
Signature of Notary Date
State of Florida, County of St. Lucie County
Towing ins en was ac owledged before me this
Il
day of 2Z by
Signature
to
""" KAREN S. NIELSEN
State of Florida -Notary Public
Revised 04/15/16 - _ Commission N GG 207484
My Commission Expires
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