HomeMy WebLinkAboutChange of Contractor RECEIVED
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION OCT 14,1010
2300 VIRGINIA AVE permitting.Department
- FORT PIERCE, FL 34982 St. Lucie County
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
0 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 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: 0J)'31 C'-S40�C.
Site Address: 3 b .1 r+rr�rizS �c:�. art }�►e�ce,, FL 3�(�S j
State License CLLISI SLC License
OrigMal GC, subcontractor or owner/builde
State License(6L t�5°`l$1 SLC License
ttib vh
New GC, subcontractor p r 1 d I
Reason for Cancellation �- €leye-I, p,t-i c rd e-ct b �,D W S y n.S V-e-T-r^a e-1_4.-�,
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 an reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit can of b can if work as een performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GE AL CONTRA (or new G ,as a is le)
PRINT NAME 4,515 PRINT NAME Y�(
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this T following instrument was ac o&ledged before me this
Ors day of OGt`ai6er• 20 2C b day of QGT'01� by�a ReQ�
. Y ��pp�� n' ` �
M y7�7f�C4//Ze�3J who is personally known to me �//� "�y/'�1 who is personally known to
or who has produced as[D. a or wh has prod ed as ID.
_ 26�—bv /%//zt3 ������NItENT� q�i /O
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Signature of Notary Date �� . 9 �i at g y 5b •' Signature of Nota Date
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Revised 09/15/16 '*; 4p-0 _ 00"`% MARK SPIEGEL
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y •.;�� �e5. d EXpIItES:May 16,2023.
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