HomeMy WebLinkAboutChange of ContractorCC?UNT ,
F i 0 a I n A
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'
CHAN.GE.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 hew 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 S2,500 ($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 Chance 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 perttut 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: July 22,2020 Permit Number: 1712-0084
Site Address: 2892 Harson.Way, Ft Pierce, Fl. 34946.
Stony Electric State License SLC. License 29620
Original GC; subcontractoror owner/builder
.3
R P C EWCAY'IC x1C'__ State License Chi( 09N SLC License
New GCj subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie Country, its officers, agents and employees from all
costs, fees or damages arising froth any and all claims of action for any reason, which may arise as a result of this change of
contractorlsubcontractor or -cancellation of permit:, A permit cannot be cancelRed if workhas been performed.
SIGNATURE OF OWNER.(orowe nedbuilder) f SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAKE �,.p'�'i1 eri FQuib/ PRINTN1At41E
State of Florida, County of Sc Lucie County
The folI wing inJ s ment was acknowledged before me this
30� by
/ is Petsonall own to me
jor who. has PF04uced as iD..
Iy22,2020
Signature of i9
Cp�.oIL�G� .o C .
C
otary Pc i At of Florida:
t,a� Wx" Cummissior = GG 320980
Revised 04/'
:• My Corrrr i irss:. r 8; 2023
Bonded thro<.eh I-otarf Assn,
State of Florida, County of St. Lucie Counry
The llowinw im en was acknowledged before me this
by of. 20`L� by
l?`Yl tivhoislRsrnallti known to
me or Mio has produced as TD
�t July 22 2020,
Sig afore of i\otary Date lot, P�au�,. AAAE L NARNER
* MY COMMISSIOW(I088172
o1TRYaUg� JA1ME L WNEM ¢ate. IXPIRSS: April 2, 2021
* MY COMMISSION A GG O t ° � tluls BudgetRlcFaty SeNioes
c� EXPlg4:.Aprl2.2021
too, F°g Bonded The ?49d t •foe:.. - ....