HomeMy WebLinkAboutChange of contractor, 11.09.20PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
v'�,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: % — r) Permit Number: T�/ 0 ��
Site Address: i a2 cQ u e �o (% fied ) Ycc, C_*.
POL 9 a � I .s C. 1-1 /5 )W, ;e. S rQD Ct, l0 State License SLC License
Original GC, subcontractor r ownerlbuilder 4 . ; ,
,,�� i "
( t J1 0,4. , etz D (L State ceense /aS 031S_6 SLC License
New GC, subcontractor
Reason for Cancellation A) n J r/u lw/-na oc e—
The undersi oes her y ee to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, or damages tsi om any and all claims of action for any reason, which;a arise as a result of this change of
co ac o a o�ntra llatio nit. A permit cannot pe canc�llel if� hffi,,been performed.
,i OWNE4Ro r�erlbuild.er) SIGNAT[1}tE GENERAL CONTRACT OR (or new GC, as applicable)
R NAME PRINT NAME -e I Lai /
State of Florida, County of St. Lucie County
The following instrument wps acknowledged before me this
.day of_� 20� by ��
_( Y (�__ who is personally known to me
or who )Qvrbdwed - i as ID,
Signature
f i�jp ,, -"
EL1D N `VA U G H N
o� a
'a State of Florida -Notary Publi
i9r
Commission # GG 270079
My Commission
Revised
P.
4`ef�,`ti
Expires
October 22, 2022
State of Florida, County of St. Lucie County ` �j /�
The following in strum n men_ t yvas aclmowl�dged before me thi , ECJ ��
_day of 20�_Q
Fwho is personally known to
me or who has produced P 1�Fl as ID.
Signature of I Date
1PavP�., ELLEN VAUGHN
°/��e��:State of Florida -Notary Public
Commission # GG 270079
=1 Vol',j1Wo`,, My Commission Expires
October 22, 2022