HomeMy WebLinkAboutchange of contractorPLANNING & 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:
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.
xx 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.
"ANCELLATION 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: 11/17/20 Permit Number: 2009-0475
Site Address: 9508 Silver Sands Lane
Hypoluxo Plumbing Inc State License CFC1430015 SLC License
Original GC, subcontractor or owner/builder
Aqua Dimensions Plumbing Services, Inc.
New GC, subcontractor
Reason for Cancellation
Change of Subcontractor
License CFC057526 SLC License
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 cannot be cancelled if work has been performed.
SIGNAT OF OWNER (or owner/builder) SIGNATURE GENERAL CO CTOR (or new GC, as applicable)
PRINT AME Lisa M Field PRINTNAME Glenn A Davis, II
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
17 day of November 20 20 , by
Lisa M Field who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16 o0Y„'fide
RHONDASROWE
Commission # GG 104656
Expires May 19, 2021
9rFpp p�o4
Bonded Thru Budget Notary Servkes
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
+7 day of "° , , 20 20 , by
Glenn A Davis 11 who is personally known to
me o who has produced as ID.
{ 1 ti NcA,.�� i dN !17/20
Signature of Notary Date
4os"Rr Po&.� RHONDA S ROWE
Commission # GG 104656
N9r \or Expires May 19, 2021
FOF W0 Bonded Thru Budget Notary servkes