HomeMy WebLinkAboutChange of Contractor i
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p 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
PL SELECT ONE OF TM 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. qq
Date: — 2 Permit Number. //,
Site Address:.1!V-LC-O 1' aV--F;4 & e FL -3 S
G r—My 0 ' M ) 11,:f&' State License SLC License
Original GC,subcontractor or owner/builder
r),W 6�'1!a 9. State License SLC License
New GC,subcontractor
Reason for Cancellation �7� S rNOL lTm
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees Q fs arising from any and all claims of action for any reason,which may arise as a result of this change of
contrac r n or canlellation of permit.A permit cannot be cancelled if work has been performed.
�
SI TOF OWNER( ownenbuil/ilder) SIGNATURE ,GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINTNAA9E
State of Florida,County of St Lucie County State of Florida.County of St.Lucie County
The following. cut was acknowledged before me this The following instrument was acknowledged before me this
day of 2t2L by {01 day of 20_,by
who is personallylmown to me who is personally known to
or a4 producedas ID, me or who has produced as ID.
Sl�ataceafDTo -.Date.. __..._ . SignAtnreoTNatary Date
Revised 04/15/16
AUDREY B.HUMPHR Y
MY COMMISSION#GG 300817
EXPIRES:March 6,2023
F°F F'°•' Bonded Thru Notary Public Undenvriturs