HomeMy WebLinkAboutChange of Contractor Apr 27 17 12:21 p Energized Gas 7728773614 p.2
III I PLANNING &DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
tOUNTY
F L 0 R I D 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PIERW
PLEASE SELECT ONE OF TIDE
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and no" 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�y the general contractor.
The now 5*contractor must fill.out a Subcontractor Agreement Form.There is a$50.00 fe6 for the Change of Sub-
Contr or..
CANCELLATION OF PERMT—The cancellation of apermit is acceptable only lino work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of redord. There is no fee for
cancellation.of the permit:
Date: PermitNumber:
Site Address: mqb- c�Nrh�Dnca- ca)IA2 , 2� '"
QLA 1State License SLC lacense
Original GC,subcontractor or owner/guilder
State License_. SLC License
New CIC,subcontractor
Reason,for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its offacers,agenti and employees from all
I t
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a MV-
of this change of
contractor/subcontractor or cancellation of permit.A permit cannot be cancelledU work-las been pefforme&
8I10NATUM OF OWNER(or owner/builder) S1ONAVJkR'GR1VrA CONTRACTOR(or nev' GO,as applicable),
PRINT NAME- PRWNAME_
State of Florida,County of SL Lucie County State of Florida,County offt Lucie County
The following instrument utas ad knowledged before me this "D le�g�be
__kv of ,20__by � !TZy 5; 201 Tby It�1-1W 401,.t
who is personally known to me who is T)ersonaliv lown to
or who has producedas11). me or w o pro
L
�' ��`
Signature of Notary Date Sigust9.1Notary' Date
publir Fiodda
Revised 04/15/16 P %
Paul* 91201ca
M 0 ion FF
019