HomeMy WebLinkAboutChange of Sub-ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE C-D
FORT PIERCE, FL 34982 FEB 2 12020
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR 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 j / values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
co encmg any work. There is 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.
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:
Permit Number: [ 10 � - bs 5�
Site Address: oZ M I tj �. 5311 Sfi'
714 14Nv't-D&-N C10PtZA0A'1Q(7- , ( P -NL State License CGG IS I_ 1ID SLC License
Original GC, subcontractor or owner/builder
n
,1 r ly a m �Le J f i G LL C State License GI 3 ®b I WLC License
New GC, subcontractor
Reason for Cancellation MCI 6WY- CjW-,Y�AaNL 50 U4
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/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
is personally ]mown to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
-�
SIGNA GENERAL CONTRA.
(or new GC, as applicable)
PRINT NAME_ Qv!% S• �, r.
State of Florida, County of St. Lucie County
T� following instrument was adaaowledged efore me is
P day o 20_.WP by ry lee, -
who is ,pppe�rrs/ronal ]mown to
me or who has nroduced , . ow. ems'lII.
Signature of Nbhry Date
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