HomeMy WebLinkAboutChange of Contractor u;r , „ •�1 PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE OCT 14,1010
FORT PIERCE, FL 34982
Permitting Department
St. Lucie County
(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 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$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to.be Signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: j o 1 t a o-�-o Permit Number: ��
Site Address: —7310 a__KeLr�o R4 Pic-ce , P-1
l�gState License GGG 1 Si 6`l o t SLC Lic_ense
Olrigi al GC, subcontractor or owner/builder
,s
_-c o f eve v.., �W y r4e_lj State License C 13 L I'a-SO I&I SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/sub contractors or
cancellation of permit.A permit canjitiNe cancelled if work has been performed.
SIGNATU OF OWNER(or owner/builder) SIGNATURE GE AL CONT OR(or new G(.-asai lic le)
PRINT NAME 1-1 cd I L?%d F PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was:acknowledged before me this The following instrument y�acknowledg before me this
Zsr day of L7C L0"/' 20 ZO by —day of &0 tl O by l� %• }-�h)A�w�J
1
M 4$*QW Avix who is personally known to me P(_1P_1C_P01�Y_I.Y)V*fwho i ersonally known o
or who has produced as ID. me or to has pr duced as ID.
%o` BEN TN6,��i�/ ' B—f rol--`�-6�
Signature of Notary Date �� �Q '9 // Signature of Notary Date
. 2 Bev'
Revised 04/15/16
*• 917 `' o= MARK SPIEGEL
2 #GG a�.,;�OQ` MY COMMISSION#GG335907
5/09••:nrougntst`�`. �4�'��� REXPIRES:May16,2023