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PLANNING &.9 ,VELOPM NT SERVICES
BUILDING & ZONING DIVISION
w.
_ 23QQ` VIRGINIA AVE
,FORT PIERCE;,- L349$21-,
(772) 462'-1553 FAX 462-157
VC
CHANiGE OF CONTRACTORi SUIBCONTRACTOR OR CANCEL,ATYON CDF PERMT
PLEASE SELECT QNE OF:THE FOLLOWING:
CIiANGE OF CONTRACTOR; Change of Contractor is to.be signed and;notarizedby the-;property.owner;
and t}ie new contractor of record for the cufreri permit:A:tiew;permit applicatiori.must also.be epflipleted with new
contractor information and signature Anew Nofice of Commencement must:be filed:ln-tile neva contractor's name
for'job values.greater than'$2;50Q ($7;50.0 if A/C Change-out) A:-recorded copy must be; submitted
:mor'to
cbminlencing any work.Tfiere'is a$50.00 fee for the Change of.Contractor:
CHANGE OF SUBCONTRACTOR-Subcontractorchanges-are'to be completed by the,general4oiitiactor.
The new subcontractor must fill out a Subcontractor Agreement'Form::There is:a$50:QQ:fee:for tfig Cbige ofst&.
Contractor.
CANCELLATION`:OF FERMIT,—The-cancellation.of a`permii.is acceptable Only.,if no work has been done.
Cancellation of permit is to'be'signed,and nofarized'by`both,the owner gglif er of record.There is no'fee':for
cance11 ioai:bf'the permit:`
Date: 'ZO ;•Permit Namber SLC-4906=0675 '
Site Address:, 5436 Palmetto Ave;Fork Noce Fl 34982
Coastal Aluminum construction,.linc.=Wilkia Dramble State License SLC License X01"28
Original-GC;;subcontractor=._or.-ownerlbuilder .
rSLCLicense
St`ate L-=`ieense '
` - .
New'GC,suacontfacfor
Reason forCancellation Homeowner has decided not to haye'the railing'instalit:d.
r £he undersigned d'- hereby''agree to indemnify and hold harmless.;St-Lucie county';its afficeTs agents and;employees from°all'
.
costs;fees or damages artstng_from any.and;all claims of actlonFfor'any reason which'may arise.as aesult of this efiange
contractor/subcontractor or;cancellation ofpermit:A,perm6t carusot'be"a elled'if. rk h a ,performed
A URE'OFQVVN.ER{ort3vrner/builder Sl N 'TURF'GENERAUONTRACMk(ocnewGG'aisapplicable) "
.._... , ` .
PRINT-NAME �. ' " . .`P✓/t'Z� PRIIITN/IIvIE•.WIli12rTl�fa171�?i@._.
State of Florida;County of St.Lucie:County 'State of Florida;County of St I:aeie County.
The following instntntent-was acknowledged(before me.this The follounng instrument was acknowledggd.before nie this
day-o£ tl_��,j_ 20?C)',bye' pkil _L day of C'Ir�
bC_rTYtb4f4_ William Drambie y ;to
who�i personuliy.kttown to rrie who•is ergoniiil' kno
,o ho has >roduced IL ...'as ID.. me or who has;produced ps lD: .
S atureof•Nota - � � . �
gu. ate. ,Slgnuture of notary Date'
: ; HEATHER RING;
Revised 09I15/1fi,`
M cotrtMtsscoxsrFiaosz9 14EA7�TL1t RING'
bXpjggS.July 10,2020
YtY�gM,ti11'1140529=
t 1pli m:July-20206