HomeMy WebLinkAboutBonfiorno Change of Sub Form 9-9-2020PLANNING & DEVELOPMENT SERVICES
> > BUILDING & ZONING DIVISION
as o 2300 I PIERC , FL 3
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCON'fRAC'1'OR 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.
X 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: 09/09/2020
Permit Number: SLC 2005-2009
SiteAddress: 9500 S. Own Drive #1906. Jensen Beach, FL 34967
Accu-Temp AIC and Heating, Inc. State
Original GC, subcontractor or owner/builder
DS Air Conditioning, Inc State License CACG58715 SLC
New GC, subcontractor
Reason for Cancellation Onglnal Contractor is sick with COVID
License
I be undersigned does hereby agree to uutemnity and hold hair less St Lucic County, its officers, agents and employees front all
costs, fees or damages arising from any and all claims of action for any reason, wit y arise as a resuh of this change of
contractor/subcontractor or cxnccll0linn ofpermit. A perp3LLrnmul fed a If work has been performed.
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GNA REOFOWNER(orowner/br er) SIG iE GENERALCON"rR Rtor new CC, as applicable)
RINT NAME Jacqueline Bonforno PRINTNAME Dani Amer
State of Flonda, County orsi. Ln<ic ('aunty
State alITonds Cmmty of St. Lucic Gamy
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