HomeMy WebLinkAboutChange of Contractor RECEIVED
Planning& Development Services
Building& Code Regulations Division MAR 0 5 2018
2300 Virginia Ave.
• - Fort Pierce,FL 34982 ST, Lucie county, Permitting
(772)462-1553 Fax 462-1578
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 Sub-Contractor Agreement Form. There is a $50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: a• a 9, Permit Number:
Site Address: A U 2� C��sT Jz 9^i6
RE.tJlkf'v .Ueat iopm�omiC&2. n ADM/' State LicenseC(; 1 SLC License
Original GC,subcoAtractor or owner/builder A p�p
RO-r�1 BU C(&Y- ��4 m ADAV-.� State Licens �l,iouo1120G/SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A permit no cancelled if worts has been per ormed.
SIGNATURE OF OWNER(or owneTIZ;54
r) SIGNATURE GENERALKONTRACTOR(or new GC,as applicable)
PRINT NAME ''^5 PRINT NAME ��\ /
State of Florida,County of St.Lucie County State of Florida,County of St. Lucie County
The following insttruu eennt was acknowledged efore me ti' a The following instrument was acknowledged before me this n, �/
day of t'tAJ 20�O•by `$� �v` oZ day of --b 20 by GIS(L H V `�
who is personally know to me who is personally know to me
or wltmoduced as ID. or who a. r educed as ID.
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Signature of Notary Date Signature of Notary Date
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