HomeMy WebLinkAboutMisc Letters PLANNING & DEVELOPMENT SE
BUILDING & ZONING DIVISION
• _ 2300 VIRGINIA AVE AUG } " 2020
J FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 F'c, f' s is a s i t,_I <_ s=n
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 sub-contractor-must fill out a_Subcontractor Agreement Form. There is a$50.00.fee for-the_Change_of_Sub-
Contractor.
X 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: ��/ Permit Number: 1907-0131
Site Address: X Ave- , ro fL+_?1 e_fa .:°L 3_ 4"361
CARLOS ANDRADE-OWNER State License SLC License
Original GC,subcontractor or owneribuilder
State License SLC License
New GC,subcontractor
Reason for Cancellation SHED NOT ON PROPERTY
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
contractor/subcontracto or cancellation of permit.A permit cannot be cancelled if work has been performed.
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SIGNA OF OWNER(or owner/builde'`rI SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME etJ ft PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
IThefollowing ins ment was acknowledge J efore me this The following instnunent was aclmowledged before me this
y of ,20.DD,by� day of 20_ by
who is personally known to me who is personally(mown to
or wl has produced a ID. me or who has produced as ID.
Signature of Notare Date Signature of Notary Date
Revised 04/15/16
.t;YPyc, AUDREYB.HUMPHREY
PAY COMMISSION#GG 300817
a`. P<` EXPIRES:March 6,2023
'•'•:,oF s;°c' Bended Thru Notary Public Underwriters ,.