HomeMy WebLinkAboutchange of contractorPLANNING & 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 PERNIT
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 he 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:
9/30/2020 Permit Number: 2002-0741
Site Address:
FLORIDA STATE ELECTRIC State License SLC License 27257
Original GC, subcontractor or owner/builder
ARC MASTER ELECTRIC
New GC, subcontractor
Reason for Cancellation
License SLC License 31751
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/subcon -o cellation of permit. A permit cannot be cancelled if/work has b rformed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new CC, as applicable)
PRINT NAME MATTHEW LYLE WYNNE PRINT NAME NIATT`HE—W LYLF WYNNE
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The foollowing instrument was acknowledged before me this The following instrument was acknowledged before me this
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