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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 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: C3 6 ' O ' 2 Permit Number: .Z O O 6. Site Address: .TZ O D 5. '7• .5 v e ��f ,,die Ife- 751-1617- 10-t I �>✓ ��O�..i SO 141 Zion State License SLC_License Original GC,subcontractor or owner/builder ZaJ G G Y—na ��e YiG o•- .LIQ Gond'fi AiVate License SLC License CAC/8//55 5 3 New GC,subcontractor Reason for Cancellation e ye, -6�'o' At-,1 a r 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 co tractor/subcontractor or cancellation of permit.A permit-cannot be cancelled if work has been performed. SIGNATURE OF/OW�NpER(or owne/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME r��/CJS 0161 � Q� PRINT NAME State of Florida,County of St Lucie County State of Florida,County of St Lucie County The following i trument was acknowledged before me this The following instrument was acknowledged before me this 1 day of .20_,by da�o �. 20�by�Gl..J to is personally known to me who is personally known to orI r e as ID. ^w— me or who has produced as ID. Sr ature of No ry Date Signature of Notary Date Revised 04/15/16 i����'•: LULYGONZALEZ:KAHR , Notary Public.State ida� My CommComm.sExpiresion#GMa024Bonded through NationalNssn. PERMIT# �O ©z ISSUE DATE PLANNING&DEVELOPMENT SERVICES Building & Code Compliance Division - - BUMDING PERMIT a,A1k i eda l-d d SUB-CONTRACTOR AGREEMENT 6� AIG (/�="G''d[� [� �e��F�0 fcJ , AJ C_ have agreed to be (Company Name/Individual Name) the Sub-contractor for �(A (_C l(-C-� (Type of Trade) (Prim ntractor) For the project located at S S4 TVrf— 7'/ }- .FL 3gg6 Z Leq7--d- 3P (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. ONTRACTORA ('Qualifier) SUB-CONTRACTOR SIGNATUFit(Qualifier) Awe 'Le F 6MAJ4411fle PRINT NAME P NT AME COUNTY CERTIFICATION NUMBER !,G— COUNTY CERTIFICATION NUMBER State of Florida,County of-1'�' Fes'C State of Florida,County of a UU — The foregoing instrument was signed before me this 1SQ day of The foregoing instrument was signed before me this a' day of aoW by-�' 1.u,4 L� i>4 eJ�rzo3�by 4� i who is personally"Two or has produced a who is personally Im n or has produced a as identification ���.,,,,, JOSE F R E S N I L L O as identification. �,,,,,, JOSE FRESNILLO. ;i°`PpYPU°� State of Florida-Notary Public 2°`Pa��s State of Florida-Notary Public =* *= Commission #�rG�G�2p72747 =* * CommissionC##. 72747 ^i, FF , ommis§TUB r7cpires ;, oFe� °�' ommI04"pires Signature of Notary �iim` December 22, 2022 Signature of Notary Pu G �a, ,a� December 22, 2022 C-4i; Prin ame of Notary Public Pri Name o Notary Public Revised 11/16/2016