HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION OCT 14�2020
_ 2300 VIRGINIA AVE Permitting Department
St. Lucie County
-- - 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 he 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: 10 1 Permit`Number: 0�' d �c►ti► sty"
Site Address: —7 310 3 Y951
Cr-e a-j k4 /°� �y+5`T eta�� 1- / 'a"``5emAtate License C6,crIS1 6 i0� SLC License
Origi 1 GC, subcontractor or owner/builder
, )S a y, S 4 d j ,, State License CB6 1�0I31 SLC License
New GC, subcontractor
Reason for Cancellation
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 can a cancell if work has been performed.
SIGNATUR OWNER(or owner/builder) SIG TURE GE RAL CONTRAC (ornew GC,as ap )
PRINT NAME�d/4 e- F PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this TJ1e following instruu e t was'acknowledged before me this
1 day of QC"* 20 2d ,by day of �i_�20 by gP&r� 7',fill 4/�
/�gf74(u✓ ROSS who is personally know to me PrG�s`J�J���/`'Y°"' who is personally known to
or ho has produced as ID. a or w o has oduced as ID.
HENTAi-, iz
Signature of Notary Date 0tSSlllNEyP• �i ;S Signature of No ary Date
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Revised 04/15/16 =-k; �'�� _ "°" MARK SPIEGEL
#GG917365��; , MY COMMISSION#GG335907
2o�.'amr�.gh tstst;�•'• � � �r� EXPIRES:May 16,2023
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