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HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPME10 SERVICES ' BUILDING & ZONING DIVISION —. • �►�d— - — 2300 VIRGINIA AVE RECEIVE© FORT PIERCE, FL 34982 MAR 2 2 2019 (772) 462-1553 FAX 462-1578 ST. Lucie County, Permitting 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. 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- Co t actor. CANCELLATION OF PERNHT-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: �_3 - 20 r 20 f ( Permit Number: / / y / Site Address: �,�©u I 14-c— S'T C- C-6 KC a l U S t LL State License SLC License 2 V-1 C Original GC, subcontractor or owner/builder �r � f Aid &�6e_ State License SLC License New GC, kbeontractor / 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 tion of rmit.A permit cannot be canVle ork has been performed. SIGNA OF �WNIER(or owner/builder) SIGNATU G NERAL CON TOR(or new GC,as applicable) PRINT NAME y 1—L�1�� PRIN NAME rb2.40F&Q0 State of Florida,County of State of Florida,County of St.Lucie County The following instrument was acknowledged before me this The following instrument was acknowledged before me this day of N4 ,2019,by QAt-X--S day of MQ VCJk ,20_JJ,by JQ_W_P_ who is personally known to me C ,r OLLe who is p rsonally known to- or who has produced as ID.� e o w o 4s produced as ID. rr .1j' 24!l l o7v Signature of Notary Dare- Signature of N Date a a08/25/2019 e of Florida �►R a WENDY G.JERNIGAN Revis YPu'•. .'o �-: F 912775 '?' �= Notary Public-State of Florida 9 .� a' Commission#GG 222208 ' Ffl.°��� My Comm.Expires Sep 21,2022 Bonded through National Notary Assn.