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PLAS+TNING�&DEVEL(}PII ENT SERVIC S
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+ 23U0°' rGINIA AVEC
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Ft)RT PIERCE;FL 34982 k°
(772)462-1553 FAX 462-157$
-CHANGE-OF CONTRACTO &SUBCONTRACTOR OR CA.NUUATI 11T:+DF=PER %IT
PLEA
SE SELECT=ONE-OF'THE FoLOWING`
CHANGE OF COl�iTRACTOR Change cif.CantkActar>s f o be.signed a ld notarize by the property owner,.
and ihe.ntw contractor of reccsrii for the: cuxreiif Permit:.A new perrrtit application-inust�also be°completed with-new;
cbnWddar-idozmation and signature. A mew Notice of-Cominenceinent,irtust be filed in th new,contractor's dame
for;jab values ater._than $2 54Q $Z SOQ if A!C"Chan a-out A xecarded co :m_ be. subxtiitted Qror to
commencing any work,.There is=a$50.00'fee,for the Chadge of 011traC#®Y. - -
.'CHANGE OF'S�CONTRACT'OR-=-gubcontracto ,changes"are ata be completed y.the general coritracto .
The new subcontractor must" ll;out a 5ubcantractox Agreement Form,'There is' $50,OO:fee fort6ae.Chattge of Snb-.
Contractor-.
CA- CEI.LATIOP+t OF'PERl M",The cancellatioai of'a pe wit is.acceptable only i no work'has-been.done:,
CancellatiC►n of permit is'to.be signed and:notarized by�bi th the.owner and"qualifier of Tec,,rd. There is no,fee:fi r
cancellat od of tho;per""mit:.
Date. 4%2/2 0 Pel~mit N niber , 2007=0l
. XXX 4'37 tunap't4nn tdn "P`o?c P.cence
Slto Address.
JosB`Concre#e PertecaoNJose Vides StateLicense SLC. icense 25230
Original.GC,:'siibcontracfar ar,6wnerlbutlder
State I;icefis SL;C License
New.GC,'subcantractor
Reason for,Cancellation
Gustrimer re-uest ;. � ,
The.u_ndersigned does hereby agree to zndemnxfy and"hold harmless St L.ucle Caunty?its officersw,age , and employees fra n a21 `
oasis,fees o;damages ansuig from any and,all claims-af action"far.any reason,wh2ch may arise as a rsult of this change of:
contractor%stibcantractar or.cancellation ofgaer►tut'A gerniit cattnot be'sai>tce ed;if.w kas""been p rforpn
SIGNATURE OF OWNER,(or-ownerlbWlder) SIONATURE G' CO OIt(or ew GC,asapPiia tiie)
' Roland Sacicier Ides
PRTIVT NAME,,R. - �� , . PR "
� Stare�ofFloieda,'CoarityofStLucieCoun#y y�; 8tase:ofk7uridaCquitlyofSt.I:ucieC;oanty
The followmgmstmment was acknowledged befare me this. [ c>x�ng sn vra5 ae Iedged 6e ore mc,thts
P Qf " t _170 2 ,by 2Q� by`
d�y�i<.fl wlia.is pi�isonally' om;u.•me ,1 'th Whe is per�aall 6;,ti n,to
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or ' has aced ►w= fi4tfsiD_
PSS :° hasProdacad as`TD
Sign otsry ' 1)Ate e: slaty !>ate
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ELLE L
Revised 04I15/,1fi �lf�REYE.S .�` t1
MY COh4Mt$�4111+2 GG;i40Kt7l1'r NoCommtiss�on="GG 13 4e39t
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'dos EXPIRE^aAuguStO';?021. My Comm& �estep
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