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 ofContractor 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: ' c -I Permit Number: I S 0 V] (3-�
Site Address: �� �t/LC '�P_ T4Z i1)
State License SLC License
Original GC,subcontractor or owneribuilder
State License SLC License
New GC,subcontractor
Reason for Cancellation 1 1 �-S �a�� 1 �`� 0/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 y and all claims of action for any reason,which may arise as a result of this change of
contr'btor/kubcontractor or cancella 9,n o permit.A permit cannot be cancelled if work has been performed.
S GNATURE OF O R(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME c�Jh SIU \ �' �. PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following in tmment was acknowledged before me this The following instrument was acknowledged before me this
day of _ 20:�by day of .20_,by
who is person�t y(mown a who is personally known to
or wh as produced as me or who has produced as ID.
Signature of Na Date Signature of Notary Date
Revised 04/15 ?ysr � —AUDREYB.HUMPHREY
MY COMMISSION#GG 300817
,. EXPIRES:March 6,2023
=.9r.....P�;
••.,of c�°� Banded Thru Notary Public l)ndenvriters