HomeMy WebLinkAboutPermit Renewali
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 iC D
(772) 462-1553 FAX 462-1578 MAY 12 2020
ST. Lucie Cniinty P.,_
PLEASE SELECT ONE OF THE FOLLOWING: (1 - d a 3 - a s P dd1 - co yy,\
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: a5 I�� a09Z Permit Number: J. W/ U
Site Address:
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_An� I a P�IC, r �Y1C_ State License SLC Licens / 75(G�
OOrigi�nal GC, subcontracto`rr or owner//butlderj _
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�r Yl _ F Y1 i l� /'P[ T1. 1� State License r� SLC License -
New GC, subcontractor
Reason for Cancellation
The undersigne hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees frorr
costs, s r es arising from any and all claims of action for any reason, which may arise as a result of this change of
co wto actor or cancellation of permit. A permit cannot be cancellee work has een performed.
S ATM OF //OWWNER (or owe� nettr/tiuilder) SIGN/ IJRE ERAL CONTRACTOR (or new GC, as applicable)
PRINT INAME A"gca WPJICI..Q.L PRINT NAME J� Mg;e� �1 �J%Le
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State of Florida, County of SC Lucie County
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
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day of
acknowledg of me this
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who is personally known to me
who is p mo
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Signature of Notary Date
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Date
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SHERRI FEHLMAtt '
commission#GG187160
�t� t, DANIELLEA.ROBRAILLE
,- MY COMMISSION # GG 07A51
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Expires March 14, 2022
To_ EXPIRES: June 26,2021
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I PERMIT # � 601
D0': ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
MAY 12 2020
ST. Lucie County, Permitting
have agreed to be
(Company Name/Individual Name) Q
the 0 )p�ri r�i Qr1 Sub -contractor for ZiOajMAJ e0, JD44-
(Type of Trade) (Primary Contractor)
For the project located at i 71 �4b zj�3 i k (I 'D !�: LJ C,Ajj C, F&/2
(Project Street Address or Prooertv 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.
CONTRAC OR SI NA U E (qualifier)
PRINT NAME
W9 �s s
COUNTY CERTIFICATION NUMBER
State of Florida, County o
The foregoing instrument was signed before me this 4 day of
/Li/y , zogby .4L6�T c S�SrzyY60
o OY poet, SHERRI FEHLMAN
`e Commission#GG187160
Revised 11/16/2016
rM; �EXplfes March 14,2022
OF Flo' S.Wd Thm BOW Nobry Sovim
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SUB -CONTRACTOR SIGNATURE (Qualifier)
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PRINT NAME
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COUNTY CERTIFICATION NUMBER
State ofF7orida, County of77 L/JP.IPi
The foregoing instrument was signed before me this _L day of
Mali 20,by �Q.Y� ?IyI_
w o le ersomally Imown—Zor has produced a
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Print Name of Notary Public
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