HomeMy WebLinkAboutChange of Contractor Signed, Roofj>.
COUNTY
F L 0 a 1 D A
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:
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.
X CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Foitn. There is a $50.00 fee for the Change of Sub -
Contractor.
_ 1 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: 12/23/2020
Site Address' 20806 GLADES CUTOFF RD PROT ST. LUCIE
Permit Number:
2006-0794
J A- TAYLOR ROOFING State License SLC License 23018
Original GC, subcontractor or owner/builder
RHINO ROOFING State License 1331472 SLC License
New GC, subcontractor
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/s for cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/build
`/er) SIGNATUR�GENERRALONTRACTOR _(or new GC, as applicable}
PRINT NAM110,'7Mfz �3i,.�C./�t JP[�—�/r PRINT NA
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
-Ric following instrument was acknowledged before me this
1day o . 20`0 by
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1C7{�1YL. i C.S�d person ]v known to Inc
tt1 Comm `
corded the
R.evis&�-04/1 SJ7 Fi
rTh following it trument was acknowledged before me this
day of�, 201LJ by_.*-
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