HomeMy WebLinkAboutChange of Contractor PLANNING & 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:
X 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 SM.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 SN.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: December loth, 2020 Permit Number. SLC 2011-0371
Site Address: 7100 Brookline Ave Ft. Pierce
Jesse Laurenzano Owner/Builder State License SLC License
Original GC,subcontractor or owner/builder
Michael Zabitosky State License CCC1330062 SLC License
New GC,subcontractor
Reason for Cancellation Owner unable to install the roof
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 as been performed.
y
N RE Oy or owner/ rider) SIGNATURE GENERAL CO! CTOR(or MO
e GC as applicable)
PRZNT AME Jesse Laurenzarw �.N,� Michael Zabftosky
State of Florida,County of St.Lucie County State of Florida,County of� I N D I A<a RI V Get"—
The G(following instrument was acknowledgedd before m,this The following instrument was acknowledged before me this
-1 day of 20�,by�eSSe day of I tCEE1M10,'c^W:2(i?__0 by r'Ml YCr1 AE L ZA8(rDG (
La(A?` Mr4n Q who is personally known to me who is personally known to
or who has plpdrteed as o has produced as m.
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Signature of Notary /Date sigeatne of Nob" Date
Revised 09/15/16 ! MliiBNaft f " Y• ARMUR CUkIEN WARNER
AN Commra.Ion/1N 05343E Notary public•State of Florida
ka,_j Erpraa 1alarkdi9 `?.4 Commission t GG 937451
•°i^'•' My Comm.Expires Dec 5,2023