HomeMy WebLinkAboutChange of Contractor (Robert Dunlap)�cr o
PLANNING & 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 PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner,
and'AP e new contractor of record for the currcnt 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.
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: . CA � a�1 c� Permit Number:
Site Address: 'ei.
State Licens r LC License
Original GC, subcontractor or owner/builder
�, 1\'( D IS �C- State Licenseccac,5155�1 LC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmles3-Slt Lucie County, its officers, agents and employees froze all
cos# , ee damages arising from any and all claims of action for any reason, w ' rise as a result of this change of
c tract r/subcontracto cancellation of permit. A permit cannot be "C f wor has be n performed.
SIGNATURE OF O (or owner/builder) n % `; SIGNAT TRACTOR (or new GC, as applicable)`
PRIM NANi �/ft/J .S L j'( //� PRINT NAME [2 &",2 1
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 061- 20x3 by
as la)CCAAU+C\ who is personally known to me
or who has produced as ID.
Signature of Notary
Re
}}}I4YIP��' NICpLE; BRAii®N
tP UB
_State of Florida -Notary public
s Commission # GG 215229
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'Fo'F110 My Commissions E
May 07, 2022Aires
State of Florida, County of St- Lucie County
Th following iuFwum nt was acknowledged before me this
day of U) , 20� by
Cro is personally known to
me or who has produced as ID.
Signature of Notary Date
NlCOL€ BRATTON
State of Florida -Notary Public
= Commission # GG 215229
M Commission Expires
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May 07, 2022