HomeMy WebLinkAboutBuilding permit application PLANNING&DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
�' 2300 VIRGINIA AVE
W �
FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF C0NT&j CJOR. SUBCONTRACTOR OR CANCELLATION OF PERM
PLEASE 5FLECT-ONE.-OF THE FOLLOWIN(, :
_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 its a$50.00 fee for the Change 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.
'g°°" 0, CANCELLATION OF PERIMT—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: September 29,2020 Permit Number: [9�9-i]253
Site Address: 1908 Lynx drive, Hutchison Island, Fl 34949
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation HOA would not approve
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 aU claims of action for any reason,which may arise as a result of this change of
contract subebzztractor or cancellation of permit.A permit o unot be cancelled if work hos been performed,
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERALCONTRACTOR(ornew GC,as applicable)
PRINT NAME Robert Harper PRINTNANIE �
Stato of klorida,County of St.Luoie County State of Florida,County of St.Lucie County
The followiug instiumcnt was acknowledged before me this The following mgtr=cw was acknowledged before me this
--Lk—day o�_ 20?,by IZo W Mr day of ,20,by
VVA V_e r V __who i9 Qersan1 Uy ImaVM to me who is persmliy known to
oz taus produc as ID T me or who has pwituce t as ID.
3 dC ( 2nLa septemuer2,9,=0
ature of No y Bate 11P-t-20 Z D Sipature of Notary Date
BELINpA A,BOYO
Revised 04/15/16 Al �= Notary Public-State of Floridp
� Commission#SG 235291
:t, ded My Comm-Expires Oct 27,202I
bon through National Notary Assn.
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